VBS 2023 - Early Sign-Ups

VBS is for 4years old - 6th Grade

Parent Information

Contact

✕

First Name

Last Name

Email

Phone Number

Add another person

Student Information

Contact

✕

First Name

Last Name

Date of birth

Gender

Add another person

Please list the student(s)'s grade completed in the 2022-2023 school year.

Does your family attend church?

Yes

No

If so, what church do you attend?

Allergy Information

Do any of the student listed above have any medical allergies we need to know about? If so, please list the students name and allergy information below.

Authorize Student Pick-UP

Please list the names and phone numbers of individuals that are authorized to pick-up your student. Students will not be released to anyone not given below.

Media Release

I grant permission for Central Baptist Church to take photos/video of my child(ren) during church events and to use these images in church publications, website and social media. I understand that photos and videos will NEVER be accompanied by captions or tags that include names or any other identifying information.

Yes

No

Signature