Temple Baptist Church VBS Registration

Temple Baptist Church VBS Registration
July 19 through July 23

6:00 to 8:00 PM
Student's Full Name

First NameLast Name
Student's Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Grade Child Just Completed
Parent/Guardian Full Name

First NameLast Name
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email Address
example@example.com
Home Address

Street Address

Street Address 2
CityState / ProvincePostal / Zip Code
Emergency Contact Name (other than parent/guardian)

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
List any allergies, medical conditions, or special needs
Please provide any additional information or special instructions for your child (optional)
Should be Empty:

July 19 through July 23