FBC-Buda Vacation Bible School

Child must be 4 years old on or before September 1, 2023 to attend.

Child's Name

Parent/Guardian Name

Residence Address

Mailing Address (if different than above)

Parent/Guardian Home Phone Number

Parent/Guardian Cell Phone Number

Parent/Guardian Work Phone Number

Parent/Guardian Email

Child's Age Information

Child's Birthdate

Last Grade Completed in School

Medical Information that we need to know – please also include any food allergies: (type N/A if none)

Emergency Contacts (other than lose listed above)

Name

Telephone

Name

Telephone

Dismissal Information – who may pick up your child at the end of each VBS day?

Names of allowed person(s).

Phone Number of Allowed Pickup

Other Information:

What can you tell us about your child that will help us meet their needs?

Do we have permission to photograph your child? (It will NOT be used on social media)
—Please choose an option—YesNo

I hereby confirm that my child turned 4 on or before September 1, 2023.