VBS Registration

Child's Name(*)

Please type your full name.

Gender

Male

Female

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Child's Age(*)

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Date of Birth

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Grade Entering

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Name of Parent(s)(*)

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Street Address(*)

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City

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State

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Zip Code

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Home or Cell Phone(*)

Invalid Input (123-456-7890)

Parent/Caregiver's Cell Phone(*)

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E-mail(*)

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Home Church

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If your child would like to be put in a crew with a friend, please list the name or names below:

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Allergies or other medical conditions:

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In case of emergency, contact

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Shermont Baptist Church has my permission to use and publish my child’s picture.

Yes

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Parent/Guardian Signature(*)

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Spam Verification. Please enter the letter and number combination below.(*)

Spam Verification. Please enter the letter and number combination below.

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