Southwind
Fellowship

Southern Baptist
Church

Southwind Fellowship 
Vacation Bible School Registration Form

VBS Logo

Child's Information
First Name
Last Name

Age information (birth date for preschoolers/or last grade completed in school)   

Medical information
Medical or other information we need to know. (Please include any food allergies)

Parent / Guardian Information
First Name 
Last Name 
Address    
City         
State      
Zip Code  
Home Phone 
Cell         
Work       
Email       
       

Emergency Contacts (Need 2 names and phone numbers)
Primary Emergency Contact    
Phone          
Relationship   

Secondary Emergency Contact        
Phone          
Relationship   

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

May we have permission to photograph your child?
 Yes    No

May we have permission to use your child’s photo in church publications for the purpose of promotion?
Yes    No

Optional Information:

Do you have a home church?  Yes    No

 If so, what is the church name?   

List any prayer needs below:

Please contact me regarding Vacation Bible School.