VBS 2020 Registration Form

June 21st - June 25th / 5:50 - 8:45 pm | Please fill out this form and click submit.

Child's First and Last Name

Child's Nickname (if preferred)

Child's Gender

Please select one option.

Boy Girl

Child's Date of Birth

Address

Which grade will your child enter in the Fall of 2020?

Please select one option.

Pre-K (age 4 by 6/1/19) Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade

Child's School

Your church affiliation/name:

Mom's (or Guardian's) First and Last Name

Dad's (or Guardian's) First and Last Name

Best Phone Number to Reach Parent/Guardian

Parent/Guardian Email Address

This address will receive a confirmation email

The above-named child has my permission to participate in the CONCRETE & CRANES VBX ADVENTURE WEEK Program at Eastwood Baptist Church. If we cannot be reached in the event of an emergency, the following person is authorized to act on our child's behalf:

Emergency Contact Name

Emergency Contact's Relationship to Child

Best Phone Number to Reach the Emergency Contact

In the case of an emergency, I understand every effort will be made to contact a parent/guardian or the above-named authorized person. In the event that we cannot be reached, permission is given for emergency treatment for my child.

Parent/Guardian First and Last Name

Today's Date

If someone other than a parent/guardian will be picking up your child, please provide the following information about that person: name, relationship to child, and phone number where he/she may be reached. NOTE: This person will need to show photo ID in order for your child to be released to him/her.

Person's Name, Relationship, and Phone #

Please list any special information or health/medical conditions for your child, including allergies.

Please try to place my child in a class with (we will honor your request when possible)

Thursday, June 25th Family Picnic / Closing Program at 6pm. Will you be in attendance?

Please select one option.

Yes No

How many from your family will be in attendance?

Description

June 21st - June 25th / 5:50 - 8:45 pm

Please fill out this form and click submit.

VBS 2020 Registration Form

Description

Please Fix the Following