Vacation Bible School Form

How many children are you registering for VBS?

Child's Name

First

Last

Birthday (age 4 as of 9/1/2025)

Date

Time

2nd Child's Name

First

Last

2nd Child's Birthday (age 4 as of 9/1/2025)

Date

Time

3rd Child's Name

First

Last

3rd Child's Birthday (age 4 as of 9/1/2025)

Date

Time

Parent/Guardian's Name

First

Last

Phone

list list Name

Email

Address

Address Line 1

Address Line 2

City

State

Zip Code

Do you attend church anywhere? If yes, where?

Any allergies?

Please list all allergies and note child's name

Major illness or medical condition?

Please list medical conditions and note child

Regular medications?

Please list all medications (Note: Church staff or representatives CANNOT administer medication)

Please provide any additional information you feel we need to know.

In the event of an emergency, please list a contact name and phone number

Who will pick up your child?

I grant permission to Crowfield Baptist Church to photograph and/or record the above-named child(ren) and to use, reproduce, and publish any images or recordings of the child, in any format or media, including but not limited to the church.

Vacation Bible School

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