VBS Registration Template

VBS Registration

* Indicates required field

Child's Name *

First

Last

Contact Information

Parent/Guardian's Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Primary Number *

Secondary Number *

Email *

Child's Information

Birthdate *

Last Grade Completed *

Allergies and Medical Information *

Other Information

Emergency Contact 1 *

First

Last

Primary Number *

Secondary Number *

Emergency Contact 2 *

First

Last

Primary Number *

Secondary Number *

Who will pick up the child? *

First

Last

Who will pick up the child? *

First

Last

Who will pick up child? *

First

Last

Do you attend church? *

Yes No

Where? *

If you are visiting, who are you a guest of? *

First

Last

I understand. *

Yes

I understand that by registering and allowing my child to attend Erven Avenue's Vacation Bible School program, I am giving Erven Avenue Baptist Church, and any of its members and workers, the right to photograph and record video/audio of the aforementioned child. I understand that these will not be sold, but may be used in any form of media promotion, for either the church or the photographer/videographer that produced the picture or video.