Summer Camp Detailed Registration Form

Vacation Bible School Registration

Victor Baptist Church - July 14-18
Child's Name*

First NameLast Name
Birth Date

MonthDayYear
Grade*
Gender

MaleFemale
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Who will pick up your child?*
Parent/Guardian Information
Name*

First NameLast Name
Cell Number

Area CodePhone Number
Work Number

Area CodePhone Number
E-mail*
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number

Area CodePhone Number
Alt. Phone Number

Area CodePhone Number
Food Allergies?
Medical Concerns?
Should be Empty: