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VBS at First Baptist Wentzville June 24-29, 2018 - 6:00pm. - 8:30p.m. Free event! Ages 4 at VBS to completed 12th Grade

*First Name:___________________________________ *Last Name_________________________ *Address______________________________ *City_________________ State _______ Zip_________ *Phone Number____________________________ * Birthday_________________ *Gender: m / f *Email _____________________________________________________________ *Parent/Guardian Name(s) _____________________________________________________________ *Last Grade completed for 1st to 5th grade __________________ *Any allergies or special needs? (Use back of paper if not enough room is provided____________________________________________________________________________ *Emergency Contacts: Name _________________________________ Number____________________ Name _________________________________ Number______________________________________ *Authorized to pick up #1___________________________________________ #2__________________________________________ #3__________________________________________ #4__________________________________________ Are you a member of this church? Y N Are you a guest of a member? Y N If Yes, who_____________________________________ If you answered no above do you attend church? Y N if yes where? ___________________________ *May we have permission to photograph your child?

Y N

How did you hear about us?_____________________________________________________________ T-shirt size ____________________________ *These items need to be filled out for proper registration.