REGISTRATION FORM

We use this information to print name tags & address labels, send parent e-mails, and create emergency contact reports.  We ask for many details, but this helps us serve your family better.  Please complete each field, and do not enter "Same as above" in any field.  Thank you for your assistance!

Child's Full Name *
First Name
Middle
Last Name
Child's Gender *
Parent/Guardian's Name *
First Name
Middle
Last Name
Parent/Guardian Gender *
Child/Parent's Complete Address *
Address Line 1
Address Line 2
City
State/Prov.
Postal Code
Parent's Phone Number xxx-xxx-xxxx*
This is a: *
Additional Phone Number xxx-xxx-xxxx
This is a:
Email Address
Name of Person bringing your child to VBS *
First Name
Middle
Last Name
Relationship of Person bringing your child to VBS *
Child's Date of Birth (mm/dd/yyyy)*
Age Grade Information (as of June 5, 2017) *
Does your child have any allergies?*
If so, please list them:
List ALL of the people allowed to pick up your child and their relationship to your child. (If they are not on this list they must have the Child's Pick Up Form prior to release) *
Are there any other special considerations we should be aware of for your child?*
If so, what are they?
Emergency Contact Name: *
First Name
Middle
Last Name
Emergency Contact Person's relationship to your child? *
Emergency Contact Number: xxx-xxx-xxxx*
This is a *
Are you a member of FBC Lithia Springs?*
If not, are you a member of another church?
If so, where?
If you are visiting our church, who or what encouraged your visit?
Do we have permission to photo/video your child during the week for use in our Family Night video and on our website?*

If you have other children to register, click Submit and you will be given the opportunity to register them in a moment.