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VBS 2019 “In The Wild”

Registration Form

June 17- 21

9 am - 12:30 pm

Please fill this form out for each child you plan to register.

Student Name *
Student Name
Address *
Address
Gender *
Name of Parent/Guardian *
Name of Parent/Guardian
Home #
Home #
Mobile # *
Mobile #
Work # *
Work #
Emergency Contact Name
Emergency Contact Name
Emergency Contact # *
Emergency Contact #
Who is authorized to pick up your child? (#1 Choice) *
Who is authorized to pick up your child? (#1 Choice)
Mobile # *
Mobile #
Who is authorized to pick up your child? ( #2 Choice) *
Who is authorized to pick up your child? ( #2 Choice)
Mobile #
Mobile #
Who is authorized to pick up your child? (# 3 Choice )
Who is authorized to pick up your child? (# 3 Choice )
Mobile #
Mobile #
Are you a member of Ardella Baptist Church?
I authorize my child to be photographed at Ardella Baptist Church. Photos will be used to promote use on social media. *
T-shirts are available for $7. Would you like your child to receive one? *
What is your child's t-shirt size? *