Greater New Antioch Baptist Church

Vacation Bible School Registration Form

Name

Age*

Grade*

Address

City

Zip Code

Home Phone

Cell Phone

Email Address

Home Church

Home Phone If Different From Student

*Name (Parent)

Allergies or other medical conditions we need to be aware of

Specific Food Allergies

Emergency Contact Name

Emergency Contact Phone

Emergency Contact Name #2

Emergency Contact Phone #2

Emergency Contact Name #3

Emergency Contact Phone #3

Date Completed

*Information not needed for students in the adult class (18+)