Vacation Bible School Registration Form

Thank you. Your VBS registration has been submitted to church staff.

 

Name:
Street Address:
City:
State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Deleware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachuttets Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Oklahoma Ohio Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
ZIP:
Home Telephone:
Home Email:
Age:
Date of Birth:
Last School Grade Completed:
In case of emergency, contact:
Mother:
Father:
Other:
Allergies or other medical conditions:
Home church:
Name of a special friend your child might like to be with:
Photo Release: Please select one below. My child's photo(s) CAN be used in publicity efforts either in print or on the South Run Baptist Church web site. (No names will be used with any photo.)
Yes     No
Emergency Medical Release: By selecting this box I give the staff (both paid and volunteer) of South Run Baptist Church Vacation Bible School the authority to secure emergency medical treatment for my child should it be required.

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