Page 154 | Carpenter Street Baptist Church

Child's Name

Parent/Guardian Name

Address

(Street, City, State, Zip Code)

Mailing Address

(If Different)

Hone Phone

Work Phone

Mobile Phone

Birthdate

Last Grade Completed In School

Medical Information VBS is needed to know

(Please include allergies)

Emergency Contact

Name & Phone # (Other than listed above)

Who may pick up your child at the end of each VBS day?

Does your child attend church? If so, where?

If your child is visiting our church, who is he/she a guest of?

Permission to photograph your child?

(Yes or No)

Permission to use your child's photograph for VBS Advertising?

(Yes or No)

Solve 9 + 3 = ?

Carpenter Street Baptist Church