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Providence Baptist Church VBS 2024
Registration Form (One Per Child)
VBS is for Children Ages 4-completed 5th grade
June 24- June 28
9am-12pm (drop off begins at 8:45am)
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* Indicates required question
Email
*
Your email
Child's First Name
*
Your answer
Child's Last Name
*
Your answer
Child's Gender
*
Female
Male
Child's Birthdate
*
MM
/
DD
/
YYYY
Child's Age as of June 2024
*
Your answer
School grade completed during the 2023-2024 School Year
*
PRE-K
Kindergarten
1st
2nd
3rd
4th
5th
Child's T-shirt Size
*
Child's XS (2-4)
Child's S (6-8)
Child's M (10-12)
Child's L (14-16)
Adult S
Adult M
Adult L
Name of parent(s)/caregiver
*
Your answer
1st Contact Parent/Guardian Cell Phone #
*
Your answer
2nd Contact Parent/Guardian Cell Phone #
Your answer
Parent/Guardian Address
*
Your answer
City
Your answer
Zip
Your answer
Home Church
*
Please tell us the name of the church you regularly attend.
Providence Baptist Church
None
Other:
Allergies or other Medical Conditions
*
Your answer
Name of Emergency Contact (Other than Parent)
*
Your answer
Emergency Contact Phone #
*
Your answer
Relationship to Child
Grandparent
Other Family Member
Family Friend
Other:
Clear selection
I give permission for my child's photograph to be taken and used by PBC staff/volunteers. (Possible uses website, social media, etc.)
*
Yes
No
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