EBC 2019 VBS Registration
Parents or Guardians please complete the below blocks to register children and adults attending Emmanuel Baptist Church's 2019 Vacation Bible School.  Questions regarding VBS, or completing this form, can be directed to information@ebc-etown.org.  We thank you for your interest in this outreach event to our greater Elizabethtown, Pennsylvania community.

Please enter names LAST NAME, FIRST and phone numbers  in 717-888-9999 like format, thank you!
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Parent/Guardian - Name *
Example: SMITH, John
Parent/Guardian - Street Address *
Example: 124 Pine Street, Apt 2
Parent/Guardian - Address City *
Example: Elizabethtown
Parent/Guardian - Address State *
Example: PA
Parent/Guardian - Address Zip Code *
Example: 17022
Parent/Guardian - Best Phone *
Example: 717-689-1234
Parent/Guardian - Email Address *
Student 1 - Name *
Example: SMITH, Sally
Student 1 - Age Group *
Choose Completed Grade Year From Boxs Below
Required
Student 2 - Name
Example: SMITH, Jason
Student 2 - Age Group
Choose Completed Grade Year From Boxs Below
Student 3 - Name
Example: SMITH, Mary
Student 3 - Age Group
Choose Completed Grade Year From Boxs Below
Student 4 - Name
Example: SMITH, Brandon
Student 4 - Age Group
Choose Completed Grade Year From Boxs Below
In-Church Photographic Use *
Do we have permission to use photos of your child/children for internal use only?
Required
Promotional Church Photographic Use *
Do we have permission to use photos of your child/children for promotional use?
Required
Student Medical Information
Please provide child/children "need to know" allergy and/or medical information.  
Alternate Pick-Up / Emergency Contact Information
Please provide alternative adult pick-up and/or emergency contact information important to your family setting.
How did you learn of our event? *
Please provide how you heard about our event.
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