Puckett Baptist Church - VBS

VBS - Registration 2025

Child Information:

First Name

Last Name

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Parent/Gaurdian Information:

First Name

Last Name

Parent/Gaurdian address if different than above

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Contact Information:

Cell Number

Home Number

Work Number

Email

Age Information:

Birthdate

Last Grade Completed:

Medical Information:

Medical Information we need to know. (Please include food allergies.)

Emergency Contact (Other than listed above)

Other Information:

Does your child attend church? If so, where?

If your child is visiting our church, who is he/she a guest of?

May we have permission to photograph your child?

Yes

No

May we have permission to use your child's photograph for the purpose of promotion?

Yes

No

To Register another child, be sure to click SUBMIT above and then select REGISTER ANOTHER below:

Register Another