Berean Baptist Church 2026 VBS Registration

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PARENT/GUARDIAN INFORMATION

Name

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Address

*

Phone

*

Email

*

This address will receive a confirmation email

May we have permission to photograph your child?

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Please select one option.

Yes No

May we have permission to use your child's photograph for the purpose of promotion?

*

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Yes No

CHILD & SIBLINGS INFORMATION

Child Full Name

Child Date of Birth

Child Grade

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Pre-K Kindergarten 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th

Child Photo

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List MEDICAL INFORMATION (Including any food allergies)

Sibling (1) Full Name

Sibling (1) Date of Birth

Sibling (1) Grade

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Pre-K Kindergarten 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th

Sibling (1) Photo

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List MEDICAL INFORMATION (Including any food allergies)

Sibling (2) Full Name

Sibling (2) Date of Birth

Sibling (2) Grade

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Pre-K Kindergarten 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th

Sibling (2) Photo

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List MEDICAL INFORMATION (Including any food allergies)

EMERGENCY CONTACT INFORMATION

Emergency Contact Full Name

Emergency Contact Phone

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** I understand that by entering my name in the box above, I am providing my digital signature on this Form. **

Description

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