Shiloh Baptist Church - Vacation Bible School 2011 Online Registration

Vacation Bible School 2011 Registration Form
Ages 3 (as of 09/01/10) thru 5th Grades COMPLETED
*Required Fields
VBS REGISTRANT INFO:
Students Name*
Birthday*
Age*
Grade completed as of May 2011*
School Attended in 06/10
Names and ages of Brothers/Sisters attending VBS
Parents/Guardian Names*
Email*
Verify Email*
Address*
City*
State*
Zip*
Home Phone*
Work Phone
Cell Phone
OTHER INFO:
How did you hear about our VBS?
Emergency Contact (Name and number in case you cannot be reached)*
Relationship
The following adults are allowed to pick up my child.
Medical or other information we need to know. (Please include any food allergies)
Do you attend Sunday School? If so, where?
If you are visiting Shiloh, who are you a guest of?
Would you like to know more about Shiloh Baptist Church?	Yes No
PHOTOGRAPHY RELEASE
May we have your permission to photograph your child?	Yes No
May we have your permission to share your child's photograph during an event or for promotion of VBS?	Yes No

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Vacation Bible School 2011 Registration Form