Professional Development Workshop Registration Form

Register VBS 2019 "Incredible Race" ~ Heritage Baptist

Please fill in the form below:
Childs Name *

First Name Last Name
Gender *
Birthdate *

Month Day Year
Date Date Picker Icon
Grade Completed *

Address *

Parents / Guardian *

First Name Last Name
Home Phone Number *

Area Code Phone Number
Work Phone Number *

Area Code Phone Number
Cell Phone Number *

Area Code Phone Number
E-mail *
Emergency Contact *

First Name Last Name
Relationship to Child *
Emergency Contact Phone *

Area Code Phone Number
Please Place My Child With
Home Church
Food Allergies?
List Any Food Allergies
Medical Concerns?
List Any Medical Concerns
I Give Permission to Use Images and Video* - Read Below *
* Permission to Use Images and Video - I hereby grant permission for Heritage Baptist Church to record sounds, images, or video of my child while attending Vacation Bible School. I also give permission for Heritage Baptist Church at its sole discretion, to use these sounds, images, or videos in publications (including print, websites, and social media platforms owned by Heritage Baptist Church in relation to "VBS Incredible Race" 2019.
Should be Empty:

Register VBS 2019 "Incredible Race" ~ Heritage Baptist