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2022 FBC Middletown VBS Registration
June 12th-16th, 2022 | 11721 Main Street | Middletown, KY 40243 | 502-245-7889
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* Indicates required question
Participant's Full Name:
*
Your child's first and last name.
Your answer
Parent/Guardian's Full Name:
*
The parent or guardian's full name.
Your answer
Address:
*
The participant's full address including City, State, Zip.
Your answer
Home Phone:
The participant's home phone.
Your answer
Cell Phone:
*
The parent/guardian's cell phone.
Your answer
Email:
*
The parent/guardian's email address.
Your answer
Participant's Birthday:
*
The participant's birthday (MM-DD-YYYY)
Your answer
Last Grade Completed:
*
The current age or last grade the participant completed as of June 2022.
Choose
3 year old
4 year old
5 year old
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Allergies, Medical & Special Needs:
Leave blank if none.
Your answer
Emergency Contacts - Name + Phone
*
Please enter one or more emergency contact name(s) and phone number(s).
Your answer
Authorized Pickup Names
*
Please enter one or more authorized pickup names. Photo ID is required for pickup.
Your answer
Where do you go to church?
Here - First Baptist Middletown
None
Other:
Participant Photograph Permission
*
May we have permission to use your child's photograph in church publications?
Yes
No
Required
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