JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
2023 VBS Registration
June 25-June 30, 2022 (6p.m.-9p.m. nightly)
Event Address: 1544 Old Appling Harlem Hwy, Harlem, GA 30813
Contact us at 706-556-1477 or
pbc@powellbaptistchurch.com
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Child's First Name
*
Your answer
Child's Last Name
*
Your answer
Gender
*
Female
Male
May we have permission to photograph your child?
*
Yes
No
Do you go to church? If so, where?
*
Your answer
Birthday
*
MM
/
DD
/
YYYY
Grade Just Completed
*
Pre-K
Kindergarden
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Required
Allergies (if yes please tell us)
*
Your answer
Parent First & Last Name
*
Your answer
Parent Contact Number
*
Your answer
Email
*
Your answer
Address
*
Your answer
Emergency Contact Name and Number
*
Your answer
Authorized Pick Up (first and last name):
*
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
