First Baptist Church

• • Child's Name *
    
    First
    
    Last
• • Parent/Guardian Name *
    
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    Last
• • Address *
    
    Street Address
    
    Other Address (optional)
    
    City
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    Country
• • Home Phone Number
    
    
    
    
    
    
• • Work Phone Number
    
    
    
    
    
    
• • Mobile Phone Number
    
    
    
    
    
    
• • Email
    
    
• • Birth Date *
    
    
• • Last Grade completed in school *
    ...Kindergarten1st2nd3rd4th5th
    
• • Medical Information *
    
    Medical or other information we need to know. (Please include any food allergies)
• • Emergency Contact *
    
    
• • Emergency Contact Phone Number *
    
    
    
    
    
    
• • Emergency Contact #2
    
    
• • Emergency Contact #2 Phone Number
    
    
    
    
    
    
• • Dismissal Information *
    
    Who may pick up your child at the end of each VBS day?
• • Do you attend Sunday School? If so where?
    
    
• • If you are visiting our church, who are you a guest of?
    
    
• • May we have permission to photograph your child? *
    Yes
    No
    
• • May we have permission to use your child's photograph for the purpose of promotion? *
    Yes
    No
    

Authentication Text*
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