Main Street Baptist Church VBS Registration Form
July 14-18 9am - 12pm
Registration Date
-
Month
-
Day
Year
Date
Student Name
First Name
Last Name
Age
Date of Birth
-
Month
-
Day
Year
Date
Please select the grade your student has completed. Must have completed prek or turned 4yrs old already.
Please Select
Prek 4yrs
Prek 5yrs
Kindergarten
1st
2nd
3rd
4th
5th
Gender
Male
Female
Student Name
First Name
Last Name
Age
Date of Birth
-
Month
-
Day
Year
Date
Please select the grade your student has completed. Must have completed PreK or turned 4yrs old already.
Please Select
Prek 4yrs
Prek 5yrs
Kindergarten
1st
2nd
3rd
4th
5th
Gender
Male
Female
Student Name
First Name
Last Name
Age
Date of Birth
-
Month
-
Day
Year
Date
Please select the grade your student has completed. Must have completed prek or turned 4yrs old already.
Please Select
Prek 4yrs
Prek 5yrs
Kindergarten
1st
2nd
3rd
4th
5th
Gender
Male
Female
Student Name
First Name
Last Name
Age
Date of Birth
-
Month
-
Day
Year
Date
Please select the grade your student has completed. Must have completed PreK or turned 4yrs old already.
Please Select
Prek 4yrs
Prek 5yrs
Kindergarten
1st
2nd
3rd
4th
5th
Gender
Male
Female
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian Information
Name 1
First Name
Last Name
Relationship
Cell Number
Please enter a valid phone number.
Is it alright to text you?
Yes
No
Name 2
First Name
Last Name
Relationship
Cell Number
Please enter a valid phone number.
Is it alright to text you?
Yes
No
Home Church Name
Authorized person who can pickup the child on dismissal
First Name
Last Name
Authorized person who can pickup the child on dismissal
First Name
Last Name
How did you learn about our VBS?
Facebook
Website
A Friend
Banner
Other
Agreement
I allow my child to participate in Vacation Bible School at Main Street Baptist Church.
I authorize the volunteer personnel to conduct first aid, and medical care in the event of an emergency situation.
Would it be okay if we take photos and videos of the participant during the activity which will be posted in our social media account?
Yes
No
Parent/Guardian Signature
Date Signed
-
Month
-
Day
Year
Date
For more information please contact
Cyndi Chambers at
msbc.cyndi@gmail.com
or 918-689-6123.
Submit
Submit
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