VACATION BIBLE SCHOOL!

REGISTER HERE

**Each child will need to be registered individually!**

Child's Name

First Name

Last Name

Grade Child is Entering

Gender

Date of Birth

YYYY

Known Allergies

Medical Concerns

Comments

Parent/Guardian Name

First Name

Last Name

Parent/Guardian Phone

(###)

###

####

Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact Name

First Name

Last Name

Relationship to Child

Emergency Contact Phone

(###)

###

####

Alternate Pickup Person

Someone other than yourself who is authorized to pickup your child

Alternate Pickup Person

Someone other than yourself who is authorized to pickup your child

DTOUR YOUTH MINISTRY IS A MINISTRY OF PINE BAPTIST CHURCH