Kentuck Baptist Church
Vacation Bible School

 

June 13 – June 18, 2010

6:20 p.m.-9:00 p.m.

**Sunday through Friday**

**Friday Night is Family Night with Dinner Provided!!**

 

Registration Form

Child’s Name: ________________________________________________

AGE:  _________  Birthdate: (M/D/YR) _______________

Parent/Guardian Name: _________________________________________

Home Address: _______________________________________________

       Please include, city, state, and zip code

Home Phone: _______________________  Cell Phone:  _____________________

Medical Info (Food Allergies):  _________________________________________

______________________________________________________________________

Emergency Contact: ______________________ Phone: ______________________

Who may pick up your child from VBS other than you?  ___________________

_______________________________________________________________________

***May we have permission to photograph your child and use it in a church publication? Check one [    ]  YES               [    ]  NO

T-SHIRT Size:  ________  Youth (S, M, L)  Adult (S, M, L, XL)

Please mail your completed form to the church:

KBC, 1845 Kentuck Church Rd., Ringgold, VA  24586