Vacation Bible School 2024 - BREAKER ROCK BEACH

RESPONSIBLE ADULT INFORMATION

Name

This address will receive a confirmation email

Phone

Address

Emergency Contact(s)

We regularly attend church at:

CHILD 1 INFORMATION

Child 1: Last Name

Child 1: First Name

Child 1: Date-of-Birth

Child 1: Age/Grade Completed at VBS start

Child 1: Medication, allergies, other

CHILD 2 INFORMATION

Child 2: Last Name

Child 2: First Name

Child 2: Date-of-Birth

Child 2: Age/Grade Completed at VBS start

Child 2: Medication, allergies, other

CHILD 3 INFORMATION

Child 3: Last Name

Child 3: First Name

Child 3: Date-of-Birth

Child 3: Age/Grade Completed at VBS start

Child 3: Medication, allergies, other

CHILD 4 INFORMATION

Child 4: Last Name

Child 4: First Name

Child 4: Date-of-Birth

Child 4: Age/Grade Completed at VBS start

Child 4: Medication, allergies, other

CHILD 5 INFORMATION

Child 5: Last Name

Child 5: First Name

Child 5: Date-of-Birth

Child 5: Age/Grade Completed at VBS start

Child 5: Medication, allergies, other

Description

June 24-28, 6:30pm - 8:30pm

Complete this form for up to five kids at one time and click Submit. Complete additional registrations as needed for additional kids.

Ages 3 (potty-trained) to
Completed Grade 5

JUNE 24-28
6:30pm - 8:30pm

Burtonsville Baptist Church
3400 Spencerville Rd
Burtonsville, Maryland 20866

Vacation Bible School 2024 - BREAKER ROCK BEACH

Description

Please Fix the Following