Username^*

Password^*

Password must be at least 7 characters long.

Enter password again^*

Password must be at least 7 characters long.

Parent's Information

First Name^*

Last Name^*

Email^*

Cell^*

Address *

Address Line 1

Address Line 2

City

State or Region

Country

Zip

Authorized Pickup List

Number of People on the Pickup List

Full Name of Pickup Person 1^*

Relationship - Pickup Person 1^*

Cell Phone - Pickup Person 1^*

Full Name of Pickup Person 2

Relationship - Pickup Person 2

Cell Phone - Pickup Person 2

Full Name of Pickup Person 3

Cell Phone - Pickup Person 3

Relationship - Pickup Person 3

Child's Information

Number of Children Registering

1st Child's Full Name^*

Alergies or Special Needs - Child 1 (or enter none)^*

Gender - Child 1^*

Girl
Boy

Age - Child 1^*

Grade Just Completed - Child 1^*

Shirt Size - Child 1^*

2nd Child's Full Name^*

Alergies or Special Needs - Child 2 (or enter none)^*

Gender - Child 2^*

Girl
Boy

Age - Child 2^*

Grade Just Completed - Child 2^*

Shirt Size - Child 2^*

3rd Child's Full Name

Gender - Child 3^*

Girl
Boy

Age - Child 3

Grade Just Completed - Child 3

Shirt Size - Child 3

Alergies or Special Needs - Child 3 (or enter none)

4th Child's Full Name

Gender - Child 4^*

Girl
Boy

Age - Child 4^*

Grade Just Completed - Child 4^*

Shirt Size - Child 4^*

Alergies or Special Needs - Child 4 (or enter none)^*

5th Child's Full Name

Gender - Child 5^*

Girl
Boy

Age - Child 5^*

Grade Just Completed - Child 5^*

Shirt Size - Child 5^*

Alergies or Special Needs - Child 5 (or enter none)^*

Emergency Medical Treatment & Photography Authorization^*

By Checking This Box I Agree With The Following

I give First Baptist Church, and those acting as its agents, permission to authorize medical or dental treatment for my child, including transportation to a hospital, in the event of an emergency. I further give my permission for photographs or video of my child to be taken as they participate in VBS activities. Images will never be associated with names or other personal information.

Parent's Information

Authorized Pickup List

Child's Information

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