2019 VBS Registration Form

Parent / Guardian Information
Mom's Name / Guardian 1
First Last
Dad's Name / Guardian 2
First Last
Primary Email*
Address
Street Address City ZIP / Postal Code
Mom's / Guardian 1 Phone
Dad's / Guardian 2 Phone
Alt Emergency Phone
Church you attend?
How often do you attend?
Child 1
Name*
First Last
Age*
Grade Completed*
Allergies?
Child 2
Name
First Last
Age
Grade Completed
Allergies?
Child 3
Name
First Last
Age
Allergies?
Grade Completed
By registering my child, I understand they may be in photos, videos, and social media used by Eastern Hills Baptist Church*
- I agree.
Email
This field is for validation purposes and should be left unchanged.

Parent / Guardian Information