VBS 2025 Registration To better serve your family, please provide the information requested below. Each child attending VBS will need a separate form completed with their information. Child's Name * First Name Last Name Child's Birthdate * MM DD YYYY Child's Last Grade Completed In School * 4K 5K 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade 9th Grade 10th Grade 11th Grade 12th Grade Parent/Guardian's Name * First Name Last Name Guardian's Phone Number * (###) ### #### Guardian's Email Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Mailing Address (if different) Emergency Contact * Other than guardian listed above. First Name Last Name Emergency Contact's Phone Number * (###) ### #### Medical Information. Please include any allergies, necessary medications, or accommodations needed. Does your child have special needs or need accommodations? If so, please describe below. (e.g. Autism, ADHD, Sensitive to loud noises, Physical Disability) Adults Authorized to Pick-Up Your Child From VBS * Please provide full names (first and last.) Please list all children (first and last names) who will be picked-up in the same vehicle. * I give permission for photographs of the child listed above to be used in publications of First Baptist Church of Burnettown (including the church website and social media.) I understand that these photos may be viewed by anyone but no identifying information will be displayed. * Yes, I give permission. No. Please do not photograph my child. Does your child attend Sunday School? If so, where? * If your child is visiting with us, are they a guest of another child? If so, who? Additional Information/Notes to VBS Leader Thank you!
