Vacation Bible School Registration Form
Bellview Baptist Church
Vacation Bible School
June 23 - 27
6 PM - 8:30PM
for children Kindergarten - Middle School
A completed form is required for each child enrolled.
Child's Name
First
Last
Parent's Name
First
Last
Address
Street Address
City
State / Province / Region
Postal / Zip Code
Grade Going Into
Gender
Birthdate
/
MM
/
DD
YYYY
Age
Home Phone
-
(###)
-
###
####
Cell Phone
-
(###)
-
###
####
Work Phone
-
(###)
-
###
####
Parent's Email Address
Attend What Church
List Allergies
List Major Illnesses/Special Needs
List Regular Medications
Note: Medication cannot be administered by Church Staff or representatives
Emergency Contact #1
First
Last
Phone
-
(###)
-
###
####
Emergency Contact #2
First
Last
Phone
-
(###)
-
###
####
Who will pick up child daily?
Children will only be released to the person listed on the Registration Form.
How did you hear about VBS @ Bellview?
I attend Bellview
print ad
church website
Yard Sign
Social Media
personal invite from
other
Bellview Baptist Church has my permission to publish any pictures that the above named child might appear in on their website, Facebook, Videos, PowerPoint presentations, or in their newsletter or other church publications.
Yes
No
