VBS 2027-June 21-25

VBS Registration Form

Student Information

Is Your Child Spanish Speaking Only?*

Yes

1: Child's Name*

1: Birthdate*

1: M/F*

1: Preferred Name*

1: Grade Child Is Going Into*

1: Age*

2: Child's Name

2: Birthdate

2: Male/Female

2: Preferred Name

2: Grade Child Is Going Into

2: Age

3: Child's Name

3: Birthdate

3: Male/Female

3: Preferred Name

3: Grade Child Is Going Into

3: Age

4: Child's Name

4: Birthdate

4: Male/Female

4: Preferred Name

4: Grade Child Is Going Into

4: Age

Home Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Parent/Guardian Information

Name*

Home Phone*

Email*

Do You Currently Attend Church?*

Yes

If yes, what church?

I authorize the following people (must be over 17 years old) to pick up or drop off my child:

Name #1*

Name #2

Name #3

Name: 4

Medical Information

Allergies*

Emergency Contact Name*

Emergency Contact Phone#*

Relation To Child*

Hospital Preference

Insurance

VBS Registration Form

Student Information

Is Your Child Spanish Speaking Only?*

Yes

1: Child's Name*

1: Birthdate*

1: M/F*

1: Preferred Name*

1: Grade Child Is Going Into*

1: Age*

2: Child's Name

2: Birthdate

2: Male/Female

2: Preferred Name

2: Grade Child Is Going Into

2: Age

3: Child's Name

3: Birthdate

3: Male/Female

3: Preferred Name

3: Grade Child Is Going Into

3: Age

4: Child's Name

4: Birthdate

4: Male/Female

4: Preferred Name

4: Grade Child Is Going Into

4: Age

Home Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Parent/Guardian Information

Name*

Home Phone*

Email*

Do You Currently Attend Church?*

Yes

If yes, what church?

I authorize the following people (must be over 17 years old) to pick up or drop off my child:

Name #1*

Name #2

Name #3

Name: 4

Medical Information

Allergies*

Emergency Contact Name*

Emergency Contact Phone#*

Relation To Child*

Hospital Preference

Insurance

VBS Registration Form

Student Information

Parent/Guardian Information

I authorize the following people (must be over 17 years old) to pick up or drop off my child:

Medical Information

VBS Registration Form

Student Information

Parent/Guardian Information

I authorize the following people (must be over 17 years old) to pick up or drop off my child:

Medical Information

Contact Us

(505) 864-8621

info@fbcbelen.net

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Contact Us

(505) 864-8621

info@fbcbelen.net

Site Map

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