| VBS ATTENDEE:
We are glad you are coming to VBS at NMBC this year!!! |
| *Participant's First Name: |
__________________________________ |
| *Participant's Last Name: |
__________________________________ |
| *Preferred Name for Name Tag: |
__________________________________ |
| *Parent/Guardian Name: |
__________________________________ |
| *Address: |
__________________________________ |
| *City: |
__________________________________ |
| *State: |
__________________________________ |
| *Zip: |
__________________________________ |
| *Primary Phone: |
(______)______-________ |
| Work Phone: |
(______)______-________ |
| Cell Phone: |
(______)______-________ |
| *Email: |
__________________________________ |
| *Birthday: |
__________________________________ |
| *Last Grade Completed: |
__________________________________ |
| Open Arms: |
Y N (circle one) |
| Allergies, Medical, & Special Needs: |
|
| *Emergency Contact Name (1): |
__________________________________ |
| *Emergency Contact Phone (1): |
(______)______-________ |
| Emergency Contact Name (2): |
__________________________________ |
| Emergency Contact Phone (2): |
(______)______-________ |
| CANNOT PICK UP: |
|
| *Authorized Pickup #1: |
__________________________________ |
| Authorized Pickup #2: |
__________________________________ |
| Authorized Pickup #3: |
__________________________________ |
| Authorized Pickup #4: |
__________________________________ |
| *Attend North Monroe Baptist Church?: |
YES
NO
I don't have a home church (circle one) |
| VISITOR or GUEST: |
|
| VISITOR or GUEST church name: |
__________________________________ |
| *Permission to PHOTOGRAPH:: |
YES
NO (circle one) |
| May we have permission to use your child's photograph in church publications?: |
Yes No (circle one) |
| *ART CLASS - T-Shirt Size: |
__________________________________ |
| Gender: |
Male Female (circle one) |
