Russellville Baptist Church VBS 2024

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

Child's Name

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Parent/Guardian Name (First/Last)

*

Email

*

This address will receive a confirmation email

Contact Information

Home Phone

*

Cell Phone

*

Work Phone

*

Address

*

Age Information

Date of Birth

*

Last grade completed

*

Please select one option.

NA PreK K 1st 2nd 3rd 4th 5th

Medical Information

Medical

*

Please select all that apply.

Diabetic Asthma Drug allergies Other

Please list other medical information here.

*

Other Allergies

*

Please select all that apply.

Bees Wasps Nuts Dairy Blue dye Red dye Gluten Other

Please list all other allergies here.

*

Emergency Contact

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

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

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