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VBS Registration
Parent/Gardian Name
Street Address
City
State
Zip Code
Home Phone Number
Cell Phone Number
Email Address
Child #1 First Name
Child #1 Last Name
Child # 1 Gender
Male
Female
Child #1 Date of Birth
Child # 1 Last Grade Completed
Choose from dropdown list
Pre-K
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Child #2 First Name
Child #2 Last Name
Child #2 Gender
Male
Female
Child #2 Date of Birth
Child # 2 Last Grade Completed
Choose from dropdown list
Pre-K
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Child #3 First Name
Child #3 Last Name
Child #3 Gender
Male
Female
Child #3 Date of Birth
Child # 3 Last Grade Completed
Choose from dropdown list
Pre-K
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Are You a Member of North Bedford Baptist Church?
Yes
No
If your child is visiting our church, who is he/she a guest of?
Does your child attend Sunday School or Bible Study?
Yes
No
If so, where does your child attend?
May we have permission to photograph and use the image of your child?
Yes
No
(The photos will only be used for the commencement slide show at the end of the week.)
Allergies, Medical & Special Needs by child:
Emergency Contact Name 1:
Emergency Contact Phone 1:
Emergency Contact Name 2:
Emergency Contact Phone 2:
Who may pick up your child at the end of each VBS session?
Email
This field is for validation purposes and should be left unchanged.
