VBS Child Registration

Vacation Bible School Registration Form

Where: Hoffmeyer Road Baptist Church (2317 Hoffmeyer Road | Florence, SC). When: Sunday, May 31st - Thursday, June 4th from 6:00pm - 8:30pm. Who: All Kids who have completed 2K - 5th Grade. Contact: Office 843-669-3051 | hrbcadmin@hrbcflorence.com
How many children are you registering?*
Child Information
First Child
Child's Name*

First NameLast Name
Last Grade Completed*
Medical or other information we may need to know about the child (including food allergies).
Second Child
Child's Name*

First NameLast Name
Last Grade Completed*
Medical or other information we may need to know about the child (including food allergies).
Third Child
Child's Name*

First NameLast Name
Last Grade Completed*
Medical or other information we may need to know about the child (including food allergies).
Fourth Child
Child's Name*

First NameLast Name
Last Grade Completed*
Medical or other information we may need to know about the child (including food allergies).
Child Release Information
Parent/Legal Guardian Name*

First NameLast Name
Email Address*
example@example.com
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Emergency Contact 1*

First NameLast Name
Emergency Contact 1 Phone Number*

Area CodePhone Number
Emergency Contact 2

First NameLast Name
Emergency Contact 2 (other than parent/guardian listed above)

First NameLast Name
I do not wish for my child to be photographed.
Should be Empty:

Vacation Bible School Registration Form