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VBS REGISTRATION FORM
PLACE
: Highland Baptist Church • 828 9th Ave. NE • Hickory
DATES
: June 22-27 (Sun-Fri)
TIME
: 6:00 - 8:15pm
Please complete this ENTIRE registration form.
Child's First Name (PLEASE PRINT)
Last Name
Parent/Guardian First Name
Last Name
Address
Apartment, suite, etc.
City
State
Zip/Postal Code
Email
HOME Phone
CELL Phone
WORK Phone
Child's Date of Birth
Month
January
February
March
April
May
June
July
August
September
October
November
December
Date
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
Year
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
Age
Gender
Male
Female
Last School Grade Completed
(Choose one)
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Home Church
Allergies
Other Medical Information
EMERGENCY Contact #1 - First Name
Last Name
Phone Number
EMERGENCY Contact #2 First Name
Last Name
Phone Number
Are parents helping with VBS?
YES
NO
If YES, where?
Dinners for Children and VBS Workers
Sun-Thu • 5:00-5:45 • Fellowship Hall
Friday Night Commencement Service • 6:00pm
Parents are encouraged to attend. The service will be followed by BBQ Dinner for the whole family!
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