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VBS Learner Registration 2017

VBS 2017 Learner Registration

For children who have completed 4K-5th grade

**Register by June 11th to receive a free T-shirt**

First Baptist Church
300 East First Avenue
Easley, SC 29640
(864) 859-4052

June 19 - 23, 2017
Monday - Friday
9:00 AM - 12:00 PM

Parent/Guardian Information

Parent/Guardian Name:(*)
Parent/Guardian is required

Address:(*)
Address is required.

City:(*)
City is required.

State:(*)
State Required

Zip Code:(*)
Zip code is required.

Cell Phone:(*)
Cell phone is required. If you do not have a cell phone, enter home or work phone. (xxx-xxxx)

Work Phone:(*)
Work Phone is required. If you do not have a work phone, enter home or cell phone. (xxx-xxxx)

Email:(*)
Email is required. If you do not have an email address, write none.

First Child

Learner's First Name:(*)
Learner's Name required.

Learner's Last Name:(*)
Learner's Last Name is required.

Last Grade Completed as of June 2017:(*)
Grade is required.

Age:(*)
Age is Required

Gender:(*)
Gender is required.

VBS 2017 T-shirt Size:(*)
Must choose a tshirt size.

Allergies, Medical, & Special Needs. If your child has food allergies, please send a snack for your child every day: (If no allergies, write none)(*)
Allergies, Medical, & Special Needs required. If none, write none.

Second Child

Learner's First Name:
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Learner's Last Name:
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Last Grade Completed as of June 2017:
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Age:
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Gender:
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VBS 2017 T-shirt Size:
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Allergies, Medical, & Special Needs. If your child has food allergies, please send a snack for your child every day: (If no allergies, write none)
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ThirdChild

Learner's First Name:
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Learner's Last Name:
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Last Grade Completed as of June 2017:
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Age:
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Gender:
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VBS 2017 T-shirt Size:
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Allergies, Medical, & Special Needs. If your child has food allergies, please send a snack for your child every day: (If no allergies, write none)
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Fourth Child

Learner's First Name:
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Learner's Last Name:
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Last Grade Completed as of June 2017:
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Age:
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Gender:
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VBS 2017 T-shirt Size:
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Allergies, Medical, & Special Needs. If your child has food allergies, please send a snack for your child every day: (If no allergies, write none)
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Additional Information

Do you have a home church?(*)
Required.

If yes, list the church name:
Invalid Input

Emergency Contact Name(other than parent listed above):(*)
Emergency contact is required.

Emergency Contact Phone:(*)
Emergency contact phone is required. (xxx-xxxx)

Authorized Pickup Name(other than parent listed above):(*)
Authorized pickup is required.

Authorized Pickup Phone:(*)
Phone for authorized pickup is required. (xxx-xxxx)

For car tags: List first AND last name of children riding in your car. If you are not picking up children, write none. **For safety, the car tag must be with the person picking up children. If you do not have a car tag, you will have to show ID.(*)
If you are not picking up children, write none.

Individual(s) not authorized to pick up your children:
Invalid Input