VBS STUDENT REGISTRATION FORM

Acts Praise & Worship Center 7:30 a.m.-5:00 p.m. July 21 - 25, 2025 Kg - 12th

$10 for each child registered
VBS Contacts: Tamala Camp, (863) 604-6638, KT Odom (863) 604-6142, Sierra Austin (863) 255-5340, Angel Austin (863) 272 - 2066
Childs Name
Childs Birth Date

MonthDayYear
Date
Childs Age
Childs Grade
ParentGuardian Name
Phone
ParentGuardian Name
Phone
EMERGENCY INFORMATION
Emergency Contact 1
Phone
Emergency Contact 2
Phone
Doctor
Phone
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

Clear
Date

MonthDayYear
APWC, Pastor Andre C. Camp

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

(863) 534-1800
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