VBS Registration

Come join us for another fun week of VBS at Central Baptist! Our 2010 Vacation Bible School is August 2-5 in the evenings (approx. 6:00 -8:00 pm). Children who are 4 years old (as of August 1, 2010) through rising 5th grade students are eligible to participate. Please fill out the following form and click "Submit" to register your child.

Questions? Contact Nathan Taylor (nathan [at] cbcva [dot] com) or Erin Collier (erin [at] cbcva [dot] com) or call the church office at 794-8055.

Child's Information:

First Name: Last Name:

Street Address:

City: Zip Code:

Birth Date:

School Year for the 2010-2011 year:

4 Year Old Third Grade

Kindergarten Fourth Grade

First Grade Fifth Grade

Second Grade

Does your child have any allergies? Yes No

If yes, please explain:

Does your child have any special needs or requests we should be aware of? Yes No

If yes, please explain:

Parent/Guardian Information:

First Name: Last Name:

Relationship to Child:

Home Phone: Cell Phone:

Email Address:

Emergency Contact: (please name a person we may contact in the event you cannot be reached)

First Name: Last Name:

Phone Number:

Photo Release Statement:

I give my permission for Central Baptist Church to use photographs of my child taken at this event in general publications.

Yes No

Medical Statement:

I give my permission for staff and representatives of Central Baptist Church to seek emergency medical care for my child as necessary during church events.

Yes No

**All children MUST be signed in and signed out by an appropriate adult each night.**