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Shiloh Baptist Church Copyright 2010
Vacation Bible School 2010 Registration Form
Ages 3 thru 5th Grades
COMPLETED
*Required Fields
Students Name*
Birthday*
Age*
Grade
completed
as of May 2010*
School Attended in 06/09
Names and ages of Brothers/Sisters
attending VBS
Parents Names*
Email*
Verify Email*
Address*
City*
State*
Zip*
Home Phone*
Work Phone
Cell Phone
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.
What food allergies does your
child have?
When you attend church, what
church do you attend?
Would you like to know more about Shiloh Baptist Church?
Yes
No
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