Russellville Baptist Church VBS 2024

June 2nd-7th 2024 | Russellville Baptist Church - VBS 2024
June 2nd-7th
6:00p - 9:00p
3 yrs. old - 5th Grade & adult class

Child's Name

*

Parent/Guardian Name (First/Last)

*

Email

*

This address will receive a confirmation email

Contact Information

Home Phone

*

Cell Phone

*

Address

*

Age Information

Date of Birth

*

Last grade completed

*

Please select one option.

NA PreK K 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th

Medical Information

Medical

*

Please select all that apply.

Diabetic Asthma Drug allergies ADHD Autism Sensory Disorder

Please list other medical information here.

*

Other Allergies

*

Please select all that apply.

Bees Wasps Nuts Dairy Blue dye Red dye Gluten Other

Has epipen on person?

*

Please select one option.

Yes No

Please list all other allergies here.

*

Emergency Contact (Other Than Parent)

Name (First/Name)

*

Phone

*

Dismissal Information

Who may pick up your child at the end of each VBS night? (First/Last)

*

Other Information

Does your child attend Sunday School/Church?

*

Please select one option.

Yes No

If so, where?

*

Permission to photograph your child?

*

Please select one option.

Yes No

Permission to use these photos for VBS promotion?

*

Please select one option.

Yes No

Description

June 2nd-7th 2024

Russellville Baptist Church - VBS 2024
June 2nd-7th
6:00p - 9:00p
3 yrs. old - 5th Grade & adult class

Please Fix the Following

Close