VBS Registration Form

Child Information

* Last Name * First Name MI
* Last Grade Completed in School * Date of Birth (mm/dd/yyyy)

Parent / Guardian Information

* Last Name * First Name MI
* Address
* City State Zipcode

Contact Information

* Home Phone Cell Phone
* Your Email
Mailing Address (if different from above)
City State Zipcode

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

Emergency Contacts (Other than listed above.)
* Name: * Phone:
* Name: * Phone:

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

Other Information

VBS T-shirts will be available for $5 each. Please indicate the quantity of each shirt that you would like to purchase. Payments can be given to Christy Wontz.

Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult XL
Adult 2X
Adult 3X

Does your child currently attend Sunday School?
YesNo If yes, where?
If your child is visiting our church, who are they a guest of?
* May we have permission to photograph your child?
YesNo
* May we have permission to use your child's photograph for promotion of our programs?
YesNo

Other Notes

Where We Are

Our Street Address:

8801 Perrymont Road
Richmond VA 23237

Phone Number: 804-275-1285
Email Address: info@kingslandbaptist.com

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