Child's Name

Age

Grade Completed

Address

City, State, Zip Code

Parent/Guardian

Email

Phone

Emergency Contact

Emergency Phone

Allergies/Special Needs

Church you attend

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

Would you like to receive more information about Springfield Baptist Church?

May we have permission to photograph your child?

May we have permission to use your child's photograph for the purpose of promotion?