VBS Registration Form: "Rocket Racers: On Track with Our Powerful God"

June 30 - July 3, 9am-12pm | Please fill out this form (one per child) and click submit.

Child's Name

*

Age

*

Birthday

*

Grade next school year

*

Food Allergies

*

Please select all that apply.

No Yes

If yes, please list food allergies here:

Medical Concerns

*

Please select all that apply.

No Yes

If yes, please explain here:

Parent Information

Name

*

Email

*

This address will receive a confirmation email

Phone

*

Address

*

Emergency Contact Name and Phone Number

I give permission for Bethel Baptist Church to record sounds, images, or video of my child while attending this VBS program. I also give permission for Bethel Baptist Church, at its sole discretion, to use these sounds, images, or videos in publications (including print, media, or social media platforms) owned by Bethel Baptist Church in relation to this VBS program.

*

Please select all that apply.

No Yes

Would you like to purchase a VBS T-shirt for $10?

Please select one option.

No T-shirt Child's Small Child's Medium Child's Large Adult Small Adult Medium Adult Large Adult X-Large

T-shirt Payment

No T-shirt ($0) Pay Online ($10) Pay in Person ($0)

Amount

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

June 30 - July 3, 9am-12pm

Please fill out this form (one per child) and click submit.

Please Fix the Following

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