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FBC VBS Registration
Event Timing: June 21-25, 2021
Event Address: 481 Cornishville Street, Harrodsburg KY 40330
Contact us at 859-734-7122
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General Information
Please fill out form and provide information for each child that will be attending VBS.
Child First Name
*
Your answer
Child Last Name
*
Your answer
Grade Completed
*
Preschool
Kindergarten
1st
2nd
3rd
4th
5th
6th
Birthday
*
DD
/
MM
/
YYYY
Age
*
Your answer
Parent's Name(s)
*
Your answer
Home Address
*
Your answer
Phone
*
Your answer
Alternate Phone
Your answer
Siblings attendening VBS (please list names and ages)
Your answer
Church Affiliation
Your answer
Church Membership at
Your answer
Does child need transportation provided?
*
Yes
No
Emergency Contact Information
Name of Emergency Contact
*
Your answer
Relationship to Child
*
Your answer
Phone
*
Your answer
Person(s) who may pick up the child (please list names and phone numbers)
*
Your answer
Food Alergies
*
Yes
No
If yes please list:
Your answer
Medical Concerns
*
Yes
No
If yes please explain:
Your answer
Family Doctor Name
Your answer
Doctor Phone
Your answer
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