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FBC Charleston VBS Registration
June 19-22 from 6-8:30 PM
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* Indicates required question
Child's Last Name
*
Your answer
Child's First Name
*
Your answer
Child's Age
*
Your answer
Child's Birthday
*
MM
/
DD
/
YYYY
Grade Completed
*
Pre K
K
1
2
3
4
5
Parent/Guardian Name
*
Your answer
Parent Phone
*
Your answer
Parent Email
*
Your answer
Emergency Contact #1 Name
*
Your answer
Emergency Contact#1 Relationship
*
Your answer
Emergency Contact #1 Phone
*
Your answer
Emergency Contact #2 Name
*
Your answer
Emergency Contact#2 Relationship
*
Your answer
Emergency Contact #2 Phone
*
Your answer
Allergies/ Health Concerns/ Special Needs
*
Your answer
Who is allowed to pick your child up?
Please list all names and relationships.
*
Your answer
Do we have permission to share your child's photograph on our website and/or social media pages?
*
yes
no
Electronic Parent/Guardian Signature
*
Your answer
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