Etowah Baptist Church
Wednesday, May 24, 2017
Giving...Growing...Going

Learner Registration

ONLINE REGISTRATION IS OPEN UNTIL 3:00 P.M., MONDAY, JULY 10TH

AFTER 3:00 P.M., REGISTRATION IS IN PERSON AT THE TIME OF DROP OFF

 To register your child as a Learner in our 2017 VBS please complete the following form. You must complete a separate registration form for each child that you will be bringing to VBS. All Learners must have their parent/guardian complete this form. Thank you!

 

Learner's First Name:     Learner's Last Name:    
 

Learner's Birthday (mm/dd/yyyy): 

 
Last Grade Completed (Please choose from this list):  (Grade completed as of June 2016)
 
 Gender: 
 
Street Address:    City:    State:    Zip: 
 
Allergies, Medical and Special Needs: (Leave Blank If None)
 
Parent/Guardian Name:    
 
Home Phone: (555-555-5555)    Cell Phone: (555-555-5555) 
 
Email: 
 
Emergency Contact Name #1:    Emergency Contact Phone Number #1: 
 
Emergency Contact Name #2:    Emergency Contact Phone Number #2: 
 
Authorized Pickup #1:    Authorized Pickup #2: 
 
Do you currently attend church, if so, where?    How often do you attend? 
 
May we have permission to photograph your child? Yes   No
 
May we have permission to use your child's photograph in church publications/presentations? Yes   No
 
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