FBC Emery VBS Registration

Child 1 grade 2022-23 School Year *

Child 5 Birth Date

AWANA 2022-2023 Registration

Preferred Method of Contact *

Phone call cell

Text

Email

GLORIFYING GOD BY MAKING DISCIPLES

Child 4 grade 2022-23 School Year

Child 4 Birth Date

Family Physician Phone *

Address *

Parent/Guardian's Name: *

Child 3 any allergies or special needs

Child 5 grade 2022-23 School Year

Child 4 Name:

Child 2 Birth Date

Please complete form once for each family. Thank you!

Child 2 any allergies or special needs

Child 1 Name: *

Child 4 any allergies or special needs

Child 3 Name:

Email

Child 2 grade 2022-23 School Year

Family Physician: *

Child 2 Name:

Child 5 Name:

Child 1 any allergies or special needs

Child 2 grade 2022-23 School Year

Child 3 grade 2022-23 School Year

Child 1 Birth Date *

Parent/Guardian 2 Cell Phone

Parent/Guardian 2 Name:

Child 5 any allergies or special needs

(1 Corinthians 10:31, Matthew 28:19-20)

First Baptist Church, Emery, SD

Child 3 Birth Date

Parent/Guardian's Cell Phone *