Vacation Bible School Registration Form for SBC

Vacation Bible School Registration Form
STUDENT INFORMATION
Name

First NameLast Name
M.I.
Gender
Grade completed by
Date of Birth

MonthDayYear
Date
Have you previously attended VBS?
If yes, what year?
Home Church (if any)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Secondary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Siblings Enrolled in VBS
Grade completed by VBS date of Sibling 1
Grade completed by VBS date of Sibling 2
Birth Date of Sibling 1

MonthDayYear
Date
Birth Date of Sibling 2

MonthDayYear
Date
EMERGENCY CONTACTS
Please list the first and last names and phone numbers off ALL adults who are allowed to pick up this child. The child will only be released to these people.
Primary Guardian

First NameLast Name
Relationship to child
Phone Number
Format: (000) 000-0000.
Alternate Guardian #1

First NameLast Name
Relationship to child
Phone Number
Format: (000) 000-0000.
Alternate Guardian #2

First NameLast Name
Relationship to child
Phone Number
Format: (000) 000-0000.
Medical Information
Please list all allergies -- or type "none" if there are none
Does your child carry an epi-pen? (please note: if yes, it is the responsibilty of the child's guardian to ensure the child has the epi-pen at every drop off and pick up)
Please list all medical concerns -- or type "none" if there are none
Additional Information
Please list the names of any other children (friends or family) that you would like placed in the same class as this child
VBS photos/videos are taken for promotional purposes related to Smyrna Baptist Church and Vacation Bible School. These pictures appear in various media outlets such as Facebook and our webpage. Do you allow your child to be included in these photos/videos?
By submitting this form, I ackowledge I have read and understand the above information.
Signature
Should be Empty:

Vacation Bible School Registration Form

Medical Information

Additional Information