VBS

VBS Registration Form

Registration Date

Child First name

Child Last name

Parent / Legal Guardian

Address

Child's Age

Last Grade Completed

Parent / Guardian Phone Number

Other Phone in case of emergency

List names of adults who have permission to pick up your child

Does your child have any allergies / medical conditions we should be aware of? If none, enter "none."

Do you and/or your children attend church on a regular basis?

YES, Kuttawa First Baptist Church

YES, Another Church

If yes, another church, what church?

Please contact me with additional information about your children's programs.

Please contact me about your programs for middle and high school students.

Please contact me about your programs for adults.

Will your child need a ride on our church bus?

Please provide any additional information we may need.