First Southern Baptist Church Pratt / Media / Vbs Registration Form

Register for our event by filling out the information below:

Child's Name (First & Last)

Last Completed Grade in School:

4 years old (Preschool)

5 years old (Preschool)

Kindergarten

1st Grade

2nd Grade

3rd Grade

4th Grade

5th Grade

6th grade

Parent/Guardian Name

Street Address

City

State

Zip Code

Email Address

Phone Number

Emergency Contact Name

Emergency Contact Phone Number

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

What church does your family regularly attend? (If none, write "none")

May we have permission to photograph your child?

Yes

No

Medical/Additional Information

VBS Registration