Vacation Bible School Registration

Child's Name

Address

City

State

Zip

Phone Number

Email Address

Parents/Guardian Name

Emergency Contact Name

Emergency Phone Number

Child's Age (Child must have completed Kindergarten to register)

Grade Completed

Where do you attend church?

Special Concerns (i.e. medical conditions, alergies or would your child like to be in a class with a friend or like a certain teacher?)

Authorized adult(s) to pick up your child from VBS/relationship (older siblings will not be allowed to pick up younger siblings.)

Would you like to assist in VBS for 2019? If so, what position?

Photo Release: My child has my consent to have their picture used in Immanuel Baptist Church promotional materials. Photo Release: My child has my consent to have their picture used in Immanuel Baptist Church promotional materials. Yes No

Number