BFBC VBS 2025 REGISTRATION

Parents Name

First Name

Last Name

Child's Name

First Name

Last Name

Birthday

MM

DD

YYYY

Last Grade Completed

Child's Name

First Name

Last Name

Birthday

MM

DD

YYYY

Last Grade Completed

Child's Name

First Name

Last Name

Birthday

MM

DD

YYYY

Last Grade Completed

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Medical (i.e. Allergies)

Food Allergies

Relationship to Child

Parent / Emergency Phone Number

(###)

###

####

Name of Home Church

Signature

I understand that my child/children may be photographed and/or videoed while attending this VBS program and these images may be used for program slideshows and/or social media event.