VBS at Dortches Baptist Church

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Event Timing: July 11-15 from 6:00-8:10 PM
Event Address: Dortches Baptist Church 4776 Dortches Blvd, Rocky Mount, NC 27804
Contact us at (252) 443-3936 or office@dortchesbc.org

Email *

Name of Parent or Guardian *

Street Address *

City, State *

Zip *

Phone Number *

Emergency Contact *

My child will be picked up by:

Special Concerns: Please list for each child any dietary restrictions, allergies, special needs, or medical concerns.

Name of Child *

School Grade Completed *

Name of Second Child

School Grade Completed

Name of Third Child

School Grade Completed

Name of Fourth Child

School Grade Completed

Name of Fifth Child

School Grade Completed

Media

Check here if you give permission for pictures of your child taken during VBS to be posted on our website and/or other forms of church media.

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