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VBS 2022 at Pleasant Grove Baptist Church
July 11th-15th, 9-11:30 AM
3255 Prince Street Conway, AR 72034
Contact us at (501) 327-2214 or
office@pleasantgroveconway.com
Please register each child individually
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Email
*
Your email
Parent/Guardian First Name
*
Your answer
Parent/Guardian Last Name
*
Your answer
Parent/Guardian Email
*
Your answer
Parent/Guardian Phone Number
*
Your answer
Child's First Name
*
Your answer
Child's Last Name
*
Your answer
Grade Entering
*
Kindergarten
1st
2nd
3rd
4th
5th
6th
Child's T-Shirt Size
*
Your answer
In Case of Emergency, Please Notify (Name and phone number)
*
Your answer
Where do you regularly worship?
Your answer
Please list any medical information, including allergies, as well as any other information we may need to help us care for your children.
Your answer
By filling out this VBS Registration I waive and release from liability, and otherwise hold harmless Pleasant Grove Baptist Church, its employees and representatives for any injury that may occur from my and my child's participation in VBS July 11-15, 2022.
*
Yes
Required
I agree to the use of any photos that might be taken during the event for future promotion
*
Yes, I agree
No, I do NOT want my child photographed
Required
A copy of your responses will be emailed to the address you provided.
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