VBS Registration – Shiloh Baptist Church

Child's Name

First

Last

In are What

Child's Birthday

Child's Last Grade Completed In School

It is ok to photograph my child

It is ok to use my child's photograph for the purpose of promoting VBS

Parent / Guardian Name

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Medical Information

Medical or other information that we need to know. Please include any food allergies.

Emergency Contact

First

Last

Emergency Contact Phone

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

First

Last

What is the name of your current church (if you attend)?

If you are visiting our church, who are you a guest of?