Child's Name *

First Name

Last Name

Parent/Guardian Name *

First Name

Last Name

Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Child's Date of Birth *

MM

DD

YYYY

Emergency Contact *

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

Photo Release: May Memorial Baptist Church/Vacation Bible School has my permission to use my child's photograph publicly in VBS materials. I understand the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use. *

Yes, I agree

No, I do not agree

I am interested in volunteering for VBS!

Yes