Register

Please complete a form for each child that will be attending Lakeview Baptist VBS 2012.

* denotes a required field

*Child's Name:
*Parent/Guardian Name
*Mailing Address
*City
*State
*Zip
Street Address (if different)
*Email Address
*Main Phone Number
*Secondary Phone Number
*Child's Birthdate
*Last Grade Completed in School
Medical Information Medical or other information we need to know. (Please include any food allergies.)
*Emergency Contact Name and Phone Number
*Dismissal Information Who make pick up your child at the end of VBS each night?
Other Information
Do you attend Sunday School?
Where?
If you will be visiting our church, who are you a guest of?
How did you hear about our VBS?
*May we have permission to photograph your child?		Yes No
*May we have permission to use your child's photograph for the purpose of promotion?		Yes No