Register for VBS

Family Information

Address

Primary Phone

Alternate Phone

Relationship to Student Father Mother Grandfather Grandmother Great-grandfather Great-grandmother Brother Sister Uncle Aunt Guardian Foster Parent Granduncle Grandaunt Other

Phone Number

Student Information

Gender

Birth Date

Age Group

Food Allergies

Details

Medical Concerns

Details

Permission to use Image and Video Yes No I hereby grant permission for Plesant Heights Baptist Church to record sounds, images, or video of my child while attending this VBS program. I also give permission for Pleasant Heights Baptist Church, at its sole discretion, to use these sounds, images, or videos in publications (including print, websites, and social media platforms) owned by Plesant Heights Baptist Church in relation to this VBS program.

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