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East Point Church VBS
Monday, June 13 - Friday, June 17
6:30pm - 8:30pm
2950 Sylvan Road
East Point, GA 30344
VBS is offered this year for ages 4 through rising 8th graders.
Please fill out a registration for each child that will be attending.
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Email
*
Your email
Child's Name
*
Your answer
Gender
*
Male
Female
Birthdate
*
MM
/
DD
/
YYYY
Grade Completed
*
Your answer
Upcoming Grade
*
Your answer
Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Parent/Guardian
*
Your answer
Parent/Guardian's Phone Number
*
Your answer
Emergency Contact Name
*
Your answer
Relationship to Child
*
Your answer
Emergency Contact Number
*
Your answer
Who can pick up your child?
*
Only the parent
Other:
Name of home church (if applicable)
Your answer
Food Allergies
*
Yes
No
Please list any known allergies
*
Your answer
Medical Concerns
*
Your answer
Do you grant permission for East Point Church to record sounds, images or video of your child in relation to this VBS program?
*
Yes
No
Prayer Request - How can we be praying for you?
Your answer
Any thing else you would like us to know?
Your answer
Parent/Guardian Signature
*
Your answer
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