Kids Backyard Bible Club Registration

Child Information
1. Child's Name 1*
First Last
Age*
Birth Date*
Month/day/year of child's birth
Child's Grade 1*
Grade child is entering in 2019-2020 school year
1b. Child's Name 2
First Last
Age
Birth Date
Month/day/year of child's birth
Child's Grade 2
Grade child is entering in 2018-2019 school year
1c. Child's Name 3
First Last
Age
Birth Date
Month/day/year of child's birth
Child's Grade 3
Grade child is entering in 2018-2019 school year
1d. Child's Name 4
First Last
Age
Birth Date
Month/day/year of child's birth
Child's Grade 4
Grade child is entering in 2018-2019 school year
1e. Child's Name 5
First Last
Age
Birth Date
Month/day/year of child's birth
Child's Grade 5
Grade child is entering in 2018-2019 school year
Parent Information
Parent(s)/Guardian(s) Name*
First Last
Primary Contact Number*
Secondary Contact Number
Address*
Street Address Address Line 2 City State ZIP Code
Medical Info/Food Allergies
Emergency Contacts: Name/Relationship/Phone*
Who may pick up your child(ren) at the end of each VBS day?*
Does your child regularly attend Church?*
- Yes
- No
If your child(ren) are visiting our Church, who are they a guest of?
May we have permission to photograph your child(ren)?*
- Yes
- No
May we have permission to use your child(ren)'s photograph for the purpose of promotion?*
- Yes
- No
Confirmation Email Address

Child Information