2025 VBS Registration

Please fill out this form and click submit.

Name of Participant

*

Gender

Please select one option.

Male Female

Birthdate

*

Grade Completed

*

Please select one option.

Pre-K K-1st 2nd-3rd 4th-6th

Address

*

Parent/Guardian

*

Phone

*

Email

This address will receive a confirmation email

Emergency Contact

*

Relationship to Child

*

Phone

*

Who Can Pick Up Your Child?

*

Name of Home Church

Allergies

*

Please select all that apply.

YES NO

If Yes, Please Specify

Medical Condition

*

Please select all that apply.

YES NO

If Yes, Please Specify

PERMISSION TO USE IMAGES AND VIDEO

I hereby grant permission for First Baptist Church Murfreesboro Arkansas to record sounds, images, or video of my child while attending the VBS program. I also give permission for First Baptist Church Murfreesboro Arkansas at its sole discretion, to use these sounds, images, or video in publications (including print, websites, and social media platforms) owned by First Baptist Church Murfreesboro Arkansas in relation to this VBS program.

Permissions

*

Please select one option.

YES, I Give Permission to First Baptist Church Murfreesboro AR to Use My Childs Images and videos.ion NO, I DO NOT Give Permission to First Baptist Church Murfreesboro AR to Use My Childs Images and videos.tion

Parent/Guardian Signature (Printed Name Will Constitute Signature)

*

Date

*

Description

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Please Fix the Following

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