VBS Registration 2016 BACKUP

Mt Olive Baptist Church Crossett AR

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VACATION BIBLE SCHOOL REGISTRATION 2016
Please complete all information
*indicates required information

CHILD INFORMATION

PARENT INFORMATION

* Indicates required field

Child's Name *

Address *

Date of Birth *

School Grade Completed *

Christian? *

Yes No

Church Member? *

Yes No

Church Name *

Relevant Medical/Allergy Information *

Emergency Contact Number *

Mother's Name *

Phone *

Address *

Email Address *

Christian? *

Yes No

Church Member? *

Yes No

Church Name *

Father's Name *

Phone *

Address *

Email Address *

Christian? *

Yes No

Church Member? *

Yes No

Church Name *

ACKNOWLEDGMENT

I understand that as a participant in vbs, I or my child may be photographed or videotaped during normal event activities, and these photos/videos may be used for promotional purposes. *

I have read and understand the above acknowledgment.

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