Pre-Register - You may register up to three children before starting a new form.

Child's first and last name: 

Street Address:

City, State Zip:

Mailing Address if Different: 

Age:     Birth Date:  

 Current Grade:  (Just completed)     Pre-K   Kindergarten  First   Second   

                                                        Third  Fourth  Fifth   Sixth

Allergies? Yes   No - if yes, to what?

Any other medical conditions? Yes   No - if yes, to what?

Is child in Sunday School?  Yes   No 
        If Yes, Where?

Any other children?  Yes   No

(If yes, you may register two other children. If no continue to the parent information.)

__________________________________________________________

Child's first and last name: 

Street Address: 

City, State Zip: 

Mailing Address if Different: 

Age:       Birth Date:  

 Current Grade:  (Just completed)     Pre-K   Kindergarten  First   Second   

                                                        Third  Fourth  Fifth   Sixth

Allergies? Yes   No - if yes, please list to what?

Any other medical conditions? Yes   No - if yes, please list.

Is child in Sunday School?  Yes   No 
        If Yes, Where? 

__________________________________________________________

Parent Information to fill out below...

Parent's Name: 

Phone #: 

Parent's Name: 

Phone #:        

Email Address: 

IF PARENT NAME or information is different for any child, please make us aware in comment section.

If an emergency, who should we contact and phone# (if not above)?

How did you learn about our Vacation Bible School (VBS)?

Note, Comments or Questions:

Enrollment Completed by: Mother  Father  Guardian/Other

 The VBS timetable is listed above. VBS will be held at Tyler Road Baptist Church, 571 S Tyler Road.
 Please arrive by 5:45 on Friday, July 8 to check in. 

 If you have any questions please call 316-722-4511 Monday - Wednesday 8:00 AM - 5:00 PM. 

  I certify that I am the legal parent and/or guardian

  I grant permission to include the above registered child/children in photographs/videos/Facebook/Website, publications for church use.

If you have not received verification of enrollment within a few days, please call 316-722-4511.