VBS Registration Form 2020

* Indicates required field.

Name of Child*

First

Last

Date of Birth*

dd/mm/yyyy

Address

Address 1

Address 2

City

Province/State

Postal Code

Country

Allergies / Medical Condition*Please say none of there are no Allergies or Medical Conditions. You cannot proceed without completing this section.

Emergency Contact*Please complete the form again for multiple children

First

Last

Phone Number (ICE)*This is intended to be an in case of emergency phone number.

Name of Parent / Guardian*

First

Last

Relationship to child

Parent / Guardian Phone No.

Parent / Guardian Mobile No

Parent / Guardian Email Address

Photography Consent*I give permission for images of my child, captured during VBS activities to be used solely for the purposes of church promotional materials.

Yes

Seventh-day Adventist® Church

Basildon District Be a Disciple to Make a Disciple

VBS Registration Form 2020

Our Beliefs