VBS 2022 Registration - Pleasant Grove Baptist Church Ellijay Georgia

Child's Name*
First Last
2nd Child's Name
First Last
Parent/Guardian Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Contact Information
Home Phone
Cell Phone
Email
Age Information (for each child)
First Child's Birth Date*
MM slash DD slash YYYY
First Child's Last Grade Completed
Fist Child's Medical Information
Medical or other information we need to know. (Please include any food allergies.)
Second Child's Birth Date
MM slash DD slash YYYY
Second Child's Last Grade Completed
Second Child's Medical Information
Medical or other information we need to know. (Please include any food allergies.)
Emergency Contacts (other than listed above)
Dismissal Information
Who may pick up your child at the end of each VBS day?
Other Information
Does your child(ren) attend Sunday School? If so where?
If your child is visiting our church, who is he a guest of?
May we have permission to photograph your child(ren)?
- Yes
- No
May we have permission to use your child(ren)’s photograph for the purpose of promotion?
- Yes
- No
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Name
This field is for validation purposes and should be left unchanged.

Contact Information