EmailMe Form - PAPBC VBS 2011 Registration

PAPBC VBS 2011 Registration
Register your child here for VBS for July 24th-29th at Princess Anne Plaza Bapt. Church.

Parent/Guardian Name *

Prefix

First *

Last *

Suffix

Child's Name *

Prefix

First *

Last *

Suffix

Last grade COMPLETED *

Address *

Street Address *

Address Line 2

City *

State / Province / Region *

Postal / Zip Code *

Country *

Email *

Home Phone Number

###

####

Cell Phone

###

####

Work Phone

###

####

Emergency Contact Name *

Prefix

First *

Last *

Suffix

Emergency Contact Phone *

###

####

Medical or other information we should know about your child. (Please inlclude any allergies.)

Who may pick up your child from VBS *

Please list anyone who is allowed to pick up your child from VBS

Do you attend church and Sunday School regularly?

Yes

If so, what church?

Would you be interested in knowing more about our church?

Yes

May we have permission to photograph your child?

Yes

May we have permission to video your child for our VBS DVD?

Yes

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