VBS Registration

555-555-5555

mymail@mailservice.com

Child's Name:

Name of Parent(s):

Address:

Phone:

Child's Age:

Date of Birth:

Child's Gender:

Last School Grade Completed:

Church Van/Bus Rider:

Known Allergies:

Email:

In Case of Emergencies, Contact:

Phone:

Relationship to Child:

Who is Allowed to Pick Up Child/Children:

Additional Comments:

Thank you for submitting your VBS registration. We will contact you if any further information is needed.

Mt Gilead Baptist Church

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