VBS 2022
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.)
Personal Information
VBS at First Baptist Middleburg is for those who will have completed Kindergarten through Grade 6 by the end of this school year.
*Participant's First Name:
*Participant's Last Name:
*Parent/Guardian Name:
*Address:
*City:
*State:
*Zip:
*Primary Phone:
(555-555-5555)
Alternate Phone:
Email:
*Birthday:
(MM/DD/YYYY)
*Gender:
*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?
*Photograph Permission:
(May we have permission to photograph your child?)
*Photo Use Permission:
(May we have permission to use your child's photograph in church publications and on social media?)
Comments:
2001-2024 Lifeway Christian Resources3.20.03
Privacy
Contact
Support