VBS 2024 Child Application

New Monmouth Baptist Church June 24th-27th 9:00am- 12:00pm | Please fill out this form and click submit.

Participant's Name:

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Grade in Fall 2024

*

Please select one option.

Kindergarten 1st 2nd 3rd 4th 5th

Birthdate:

*

Gender:

*

Please select one option.

Male Female

Allergies, Medical & Special Needs: (Leave Blank if None)

T-Shirt Size

*

Please select one option.

Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large

Parent/Guardian Name:

*

Address:

*

Email

*

This address will receive a confirmation email

Cell Phone

*

Home Phone:

Work Phone:

Emergency Contact Name (1):

*

Emergency Contact Phone (1):

*

Emergency Contact Name (2):

Emergency Contact Phone (2):

Authorized Pickup #1:

*

Authorized Pickup #2

Authorized Pickup #3

Authorized Pickup #4:

Are you a member of this church?

Please select one option.

Yes No

Guest of:

Do you attend church?

Please select one option.

Yes No

If so, where?

Comments:

Payment

Pay by card ($40.00) Pay by check (0) Request Scholarship (0)

Amount

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

New Monmouth Baptist Church June 24th-27th 9:00am- 12:00pm

Please fill out this form and click submit.

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