Vacation Bible School at First Baptist Church Durham
June 25-29, 2018
Register
 
VBS Attendee Information

 
Attendee First Name: *

 
Attendee Last Name: *

 
Attendee's Home Street Address: *

Format: Address, City, State, Zip
 
Gender: *


 
Birth Date: *

 
Please put in same class with...

If you would specifically like your child to be placed in the same class as another of the same age, please list that other child's name here. Otherwise, leave blank.
 
Allergy and Medical Information:

Please list any allergies or medical issues that we should be aware of for this attendee.
 
Parent/Guardian Information

 
Primary Parent/Guardian Contact Name: *

Please provide the name of the parent who will be the primary contact person regarding VBS.
 
Primary Parent/Guardian Contact Number: *

Please provide the best contact number in case of an emergency or if additional information is required.

Format: XXX-XXX-XXXX
 
Secondary Parent/Guardian Contact Name:

 
Secondary Parent/Guardian Contact Number:

Please provide a secondary contact number (if available) should the primary number not be available.

Format: XXX-XXX-XXXX
 
Additional Information:

 
Emergency Contact (Name): *

Please provide the name of an individual who can serve as an emergency contact in addition to the parent/guardian listed on this form.
 
Emergency Contact Phone: *

Please provide the phone number of your emergency contact.
 
Parents' Home Church *


 
Authorized Pick-Up Persons *

Please provide the name(s) of individuals who are authorized to pick up your child during VBS.

Format: Name 1, Name 2, etc.
Thank you for registering {{answer_oNccPS7r4hEU}} {{answer_EOUd4AZhNmSe}} for  VBS at First Baptist Church Durham!

You will get a confirmation email shortly at {{answer_QLjzdzhkC0UF}} with the registration information you provided.

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