VBS 2017 Learner Registration

For children who have completed 4K-5th grade


**Register by June 11th to receive a free T-shirt**


First Baptist Church
300 East First Avenue
Easley, SC 29640
(864) 859-4052



June 19 - 23, 2017
Monday - Friday
9:00 AM - 12:00 PM


Parent/Guardian Information


Parent/Guardian Name: (*)
Parent/Guardian is required
Address: (*)
Address is required.
City: (*)
City is required.
State: (*)
State Required
Zip Code: (*)
Zip code is required.
Cell Phone: (*)
Cell phone is required. If you do not have a cell phone, enter home or work phone. (xxx-xxxx)
Work Phone: (*)
Work Phone is required. If you do not have a work phone, enter home or cell phone. (xxx-xxxx)
Email: (*)
Email is required. If you do not have an email address, write none.

First Child


Learner's First Name: (*)
Learner's Name required.
Learner's Last Name: (*)
Learner's Last Name is required.
Last Grade Completed as of June 2017: (*)
Grade is required.
Age: (*)
Age is Required
Gender: (*)
Gender is required.
VBS 2017 T-shirt Size: (*)
Must choose a tshirt size.
Allergies, Medical, & Special Needs. If your child has food allergies, please send a snack for your child every day: (If no allergies, write none) (*)
Allergies, Medical, & Special Needs required. If none, write none.

Second Child


Learner's First Name:
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Learner's Last Name:
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Last Grade Completed as of June 2017:
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Age:
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Gender:
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VBS 2017 T-shirt Size:
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Allergies, Medical, & Special Needs. If your child has food allergies, please send a snack for your child every day: (If no allergies, write none)
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Third Child


Learner's First Name:
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Learner's Last Name:
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Last Grade Completed as of June 2017:
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Age:
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Gender:
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VBS 2017 T-shirt Size:
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Allergies, Medical, & Special Needs. If your child has food allergies, please send a snack for your child every day: (If no allergies, write none)
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Fourth Child


Learner's First Name:
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Learner's Last Name:
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Last Grade Completed as of June 2017:
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Age:
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Gender:
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VBS 2017 T-shirt Size:
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Allergies, Medical, & Special Needs. If your child has food allergies, please send a snack for your child every day: (If no allergies, write none)
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Additional Information


Do you have a home church? (*)
Required.
If yes, list the church name:
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Emergency Contact Name(other than parent listed above): (*)
Emergency contact is required.
Emergency Contact Phone: (*)
Emergency contact phone is required. (xxx-xxxx)
Authorized Pickup Name(other than parent listed above): (*)
Authorized pickup is required.
Authorized Pickup Phone: (*)
Phone for authorized pickup is required. (xxx-xxxx)
For car tags: List first AND last name of children riding in your car. If you are not picking up children, write none. **For safety, the car tag must be with the person picking up children. If you do not have a car tag, you will have to show ID. (*)
If you are not picking up children, write none.
Individual(s) not authorized to pick up your children:
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