PERSONAL INFORMATION:

Child's First Name:
Child's Last Name:

Mother's Name:
Father's Name:

Local Mailing Address:
City:
Zip:

Home Phone (***-****):
Cell Phone(***-****):
Other Phone(***-****):

Gender:

Girl  Boy

       Birthday (MM/DD/YYYY):

GRADE COMPLETED:

MISCELLANEOUS INFORMATION:

Do you Attend Sunday School or Church?

Yes No  Some

Where?

Person Who Invited You (if applicable):

Third Party Emergency Contact:

Phone:

Relationship to Child:

How Did You Hear About This VBS?   Newspaper   Mail-Out   Radio   Church

Friend   Drive By/Sign in font of Church   TV   Other:

I understand from time to time First Baptist Church College Station produces promotional material about this event. I understand that my child may be included in video or photographs taken at the children's events. I hereby grant First Baptist Church College Station the right to photograph and/or video tape my child and further utilize participant's name, face likeness, voice and appearance as part of the event and in advertising and promoting the event, without reservation or limitation. In granting this license, I understand that First Baptist Church College Station is under no obligation to exercise any of its rights, licenses, and privileges herein granted by participation.

YOUR e-mail address: (this is required)
You will receive an e-mail confirmation of your online registration. If, after 3-5 days you have not heard from us,
please email heather@fbcfirstkids.com as some e-mail extensions will not send this registration form.