VBS 2024 Child Registration

Please fill out this form and click submit.

Parent/Guardian Name

*

Email

*

This address will receive a confirmation email

Phone

*

Address

*

Name of your home church?

*

Emergency Contact

*

Emergency Phone Number

*

Child 1 Name

*

Gender

*

Please select one option.

Male Female

Birthday

*

Grade (What grade is your child going into?)

*

Please select one option.

K5 1st 2nd 3rd 4th 5th 6th

T-shirt Size

*

Please select one option.

YXS YS YM YL AS AM

Any food allergies or medical concerns?

*

Child 2 Name

Gender

Please select one option.

Male Female

Birthday

Grade (What grade is your child going into?)

Please select one option.

K5 1st 2nd 3rd 4th 5th 6th

T-shirt Size

Please select one option.

YXS YS YM YL AS AM

Any food allergies or medical concerns?

Child 3 Name

Gender

Please select one option.

Male Female

Birthday

Grade (What grade is your child going into?)

Please select one option.

K5 1st 2nd 3rd 4th 5th 6th

T-shirt Size

Please select one option.

YXS YS YM YL AS AM

Any food allergies or medical concerns?

Child 4 Name

Gender

Please select one option.

Male Female

Birthday

Grade (What grade is your child going into?)

Please select one option.

K5 1st 2nd 3rd 4th 5th 6th

T-shirt Size

Please select one option.

YXS YS YM YL AS AM

Any food allergies or medical concerns?

Permission to use Images and Video

I hereby grant permission to Kerwin Baptist Church to record sounds, images, or video of my Child(ren) while attending this VBS Program. I also give permission for Kerwin Baptist Church at its sole direction, to use these sounds, images, or videos in publications (including print, website, and social media platforms) owned by Kerwin Baptist Church in relation to this VBS Program.

*

Please select all that apply.

YES NO

Signature

*

Today's Date

*

Description

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