Register for VBS

Family Information

Address

Primary Phone

Alternate Phone

Emergency Contact Information

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

Phone Number

Child Pick Up

Please list the names and relationship of adults that have permission to pick up your child. (I.e., yourself, spouse, grandparent).

I hereby grant permission for Gap Creek Baptist Church to record sounds, images, or video of my child while attending this VBS program. I also give permission for Gap Creek Baptist Church at its sole discretion, to use these sounds, images, or videos in publications (including print, websites, and social media platforms) owned by Gap Creek Baptist Church in relation to this VBS program. Permission To Use Images and Video

Details

Student Information

Gender

Birth Date

For grades 1-5, please select the grade your child has completed during the 2019-20 school year.

Age Group

Food Allergies

Details

Medical Concerns

Details

I have more students to register