VBS Registration 2017

Child's First Name*

Child's Last Name*

Child's Birthday*

Child's School Grade '10-'11*

Medical Allergy Info (Please include any food allergies)*

Parent's E-Mail*

VBS STAFF ONLY*

Parent's Name*

Street Address*

City/Zip Code*

Primary Phone Number*

Alternate Phone Number*

Emergency Contact or Authorized Person for Pick-up*

Emergency Phone Number *

Do you attend Sunday School? If so where?

If your child is visiting our church, who is (s)he a guest of?

VBS T-shirts are available in the Gathering Area for $10.00. This includes the 2017 VBS music CD!

May we have permission to photograph your child?*
YES
NO

Type the code from the image

What We're Learning

Shirley Hills Baptist Church

Top