VBS2 - South River Baptist Church

Child's Name*
First Last
Age*
Date of Birth*
Month
Day
Year
Grade Just Completed:*
Select Grade Completed or Current Age of Child
Gender*
T-Shirt Size (Select One):*
Parent/Guardian Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Emergency Contact Information - Name, Relationship, Phone#*
Does Your Child Have Allergies?*
- Yes
- No
If Yes to Allergies please specify
Any special needs?
Who many pick up your child at the end of VBS other than Parent or Guardian? List all names of those with permission.
Name of person registering child for VBS*
Email of person registering child for VBS*
Do you have a church home?*
- Yes
- No
If Yes, where?