Clone of VBS Registration Form

Registration Form 2026 VBS

Clintonville First Baptist Church

If you have any issues or questions, please contact Robin at 715-281-4041 or you can email us at clintonvillefirstbaptist@gmail.com. We look forward to seeing you there.

Participant Name

First NameLast Name

Date of Birth

MonthDayYear

Age

What grade will child be in this Fall

Medical Problems/ Allergies / Special Needs

Parent / Guardian's Name

First NameLast Name

Phone Number (Daytime / Emergency)

Area CodePhone Number

Phone Number (Evening)

Area CodePhone Number

E-mail

Address

Street Address

Street Address Line 2

CityState

Zip CodeCountry

Tell us how you learned about our VBS:

CONSENT FOR MEDICAL TREATMENT | As the parent or legal guardian of the above-named participant, I hereby give my consent for emergency medical care prescribed by a duly licensed Doctor. This care may be given under whatever conditions are necessary to preserve the life, limb, or well-being of my dependent.

Parent/Guardian Signature

First NameLast Name

CONSENT FOR PHOTOGRAPHS | As the parent or legal guardian of the above-named participant, I hereby give my consent for Clintonville First Baptist to include my child in pictures as a church record of the event only. No pictures will be posted on social media or websites.

Parent/Guardian Signature

First NameLast Name

By signing and submitting this registraiton form, you agree to your child's participation in this event.

Today's Date

MonthDayYear

Comments and/or Questions:

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