VBS Newport Southern Baptist Church

Child's Name

Parent/ Guardian Name

Physical Address

Mailing Address (optional)

Home Phone

Cell Phone (optional)

Work Phone (optional)

Your email

Child's Birthdate

Child's Last Grade Completed

Is your Child Homeschooled? (Yes or No)

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

Emergency Contacts (other than listed above)

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

Does your child attend church? If so, where?

If your child is visiting our church, who is he a guest of?

May we have permission to photograph your child? (Yes or No)

May we have permission to use your child’s photograph for the purpose of promotion? (Yes or No)