Eastside Baptist Church
Monday, May 29, 2017
A great place to grow

Online VBS Registration


 
If you have multiple children with the same information, you may list them on a single entry of the form. 
Please specify all names in a comma delimited format.  Also specify each child's age/grade and specific allergies by name. 
 
* Indicates Required Fields
Child's Name
*

Parent / Guardian Name
*

Address
*

City * State * Zip *



Phone Numbers

Phone 1 * Phone 2

Email Address


Birth Date
(MM/DD/YYYY)

Grade Completed


Medical Information: Medical or other information we need to know (Please include any food allergies.)


Emergency Contacts

Name * Phone *

Name Phone

Who may pick up your child at the end of each VBS day?


May we have permission to photograph your child?     Yes No

May we have permission to use your child’s photograph in church publications for the purpose of promotion?  Yes  No