Vacation Bible School Registration 2008

Please provide the following student information:

    * = Required Fields

*Child's First Name  
*Last Name  
*Date of Birth  mo-day-yr
*Grade '07-08
*Gender Male Female

Please provide the following contact information:

Parent/ Guardian
Street Address
Address/ Apt.
City
State
Zip Code  
Work Phone
Home Phone
E-mail
Cell Phone
Additional Emergency contact
 

Where do you attend

Sunday School?
Can your child be photographed

for in-house use only?

   Yes   No
        Medical or other information, including food allergies:    

     

VBS RELEASE INFORMATION (responsible for picking up the child)

 
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Copyright © 2008 First Baptist Church, Long Beach, MS