Concrete & Cranes VBS 2021
If you or your child would like to participate in this event as a Participant, please complete the following form.

(If you are under 18, please have your parent or guardian complete the form.)

If you have previously registered with us for a prior event, you can search for your stored information instead of filling out the form below.
Personal Information
*Participant's First Name:
*Participant's Last Name:
*Parent/Guardian Name:
*Address:
*City:
*State:
*Zip:
Home Phone:
(555-555-5555)
Work Phone:
(555-555-5555)
*Cell Phone:
(555-555-5555)
*Email:
*Birthday:
(MM/DD/YYYY)
*Last Grade Completed:
Allergies, Medical, & Special Needs:
(Leave Blank if None)
*Emergency Contact Name (1):
*Emergency Contact Phone (1):
(555-555-5555)
*Emergency Contact Name (2):
*Emergency Contact Phone (2):
(555-555-5555)
*Authorized Pickup #1:
Authorized Pickup #2:
Authorized Pickup #3:
Authorized Pickup #4:
Are you a member of this church?
Guest of:
Do you attend Church?
*If so, where?
*Gender:
Medical Consent:
(By registering for VBS, I give FBC Carterville permission to treat my child's medical needs in the case of an emergency and if a parent/guardian can not be reached.)
Photo Consent:
(By registering for VBS, I give FBC Carterville permission to take my child's photograph to be used by my child for a craft project during the week & for the picture video to be shown on Family Night.)
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