VBS STUDENT REGISTRATION FORM

Acts Praise & Worship Center 7:30 a.m.-5:00 p.m. July 20 - 24, 2026 Kg - 12th

$25 for each child registered
VBS Contacts: Tamala Camp, (863) 604-6638, KT Odom (863) 604-6142, Stephanie Huggins (863) 777-0016, Aundrea Camp (863) 330 - 2055
Childs Name
Childs Birth Date

MonthDayYear
Date
Childs Age
Childs Grade
ParentGuardian Name
Phone
Format: (000) 000-0000.
ParentGuardian Name
Phone
Format: (000) 000-0000.
EMERGENCY INFORMATION
Emergency Contact 1
Phone
Format: (000) 000-0000.
Emergency Contact 2
Phone
Format: (000) 000-0000.
Doctor
Phone
Format: (000) 000-0000.
Allergies or Special Needs(describe)
Who may pick up your child at the end of each VBS day? Name
Relationship
Who may pick up your child at the end of each VBS day? Name
Relationship
ParentGuardian Signature
Date

MonthDayYear
APWC, Pastor Andre C. Camp

3824 S.R. 60 East ~ Bartow ~ FL ~ 33830

(863) 534-1800
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