Island City Baptist Church - VBS Registration

Child's First Name

Child's Last Name

Last Grade Completed & Age

Allergies (children are served a snack and drink)

Parent/Guardian First Name

Last Name

Phone Number

Child's Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Email

Emergency Contact First Name

Last Name

Emergency Contact Phone Number

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