"In the Wild" VBS 2019

Registration

“In the Wild” VBS at Old Bridge Baptist Church
July 8-12th from 10am-12pm
Please fill out one registration form per child and click submit at the bottom of the page.

Child's Name **
First Last
Child's Age **
Please enter a number from 5 to 12.
Date of Birth **
Date Format: MM slash DD slash YYYY
Last School Grade Completed **
Name of Parent/Guardian 1 **
First Last
Name of Parent/Guardian 2
First Last
Home Address **
Street Address Address Line 2 City State ZIP Code
Primary Phone **
The best way to get a hold of you if needed!
Secondary Phone
Email
Emergency Contact (other than parent/guardian) **
First Last
Emergency Contact Phone **
Relationship of Emergency Contact to child **
Medical Release **
If I cannot be reached, I grant permission to any physician or emergency medical personnel to render medical treatment necessary.
- I agree
Allergies or other medical concerns (write "None" if nothing to report) **
Media Release **
I understand and agree that Old Bridge Baptist Church retains the right to use the photographs and videotape taken at this event but will not include any of my personal information.
- I agree
- I have a question about this
Do you have a home church?
How did you hear about our VBS?
Phone
This field is for validation purposes and should be left unchanged.