Child's Name (required)

Address (required)

Parent's Name (required)

Your Email (required)

Phone Number (required)

Where Do You Attend Church? (required)

Emergency Contact Name (required)

Emergency Phone Number (required)

Authorized adults to pick up your child from VBS and their relationship. Older siblings will not be allowed to pick up younger siblings. (required)

Child's Age (required)


CHILD MUST HAVE COMPLETED KINDERGARTEN TO ATTEND VBS

Child's Grade Completed (required)

Allergies (if any)

My child has my consent to have their picture in Immanuel Baptist Church promotional materials. Please indicate yes or no. (required)

Would you like to assist in VBS 2016? If so, what position? (required)

Any additional information you would like to provide