V.B.S. VBS Dates: July 6-July 10 Family Night: July 11 VBS Commencement: July 13 VBS Registration Please fill out one form per child Please enable JavaScript in your browser to complete this form.Child Full Name *FirstMiddleLastAge *0123456789101112131415Grade (Going into) *NurseryPre-KKindergartenFirstSecondThirdFourthFifthSixthShirt Size *Youth X-SmallYouth SmallYouth MediumYouth LargeYouth X-LargeAdult SmallAdult MediumAdult LargeAdult X-LargePlease list any Allergies (food, drug, other) *If no allergies, please put N/A.Special NeedsPlease list any special needs or instructions your child may require.Parent/Guardian Name *FirstLastI.D. is required to pick up child.Relation to Child *Parent/Guardian NameFirstLastI.D. is required to pick up child.Relation to ChildAddress *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeMain Phone *Secondary PhoneEmail *Authorized Pick-Up #1FirstLastI.D. is required to pick up child.Relation to ChildPhoneAuthorized Pick-Up #2FirstLastI.D. is required to pick up child.Relation to ChildPhoneAuthorized Pick-Up #3FirstLastI.D. is required to pick up child.Relation to ChildPhonePhoto and Video Permission *YesNoMy permission is granted for KCBC to photograph or videotape the individuals listed on this form during Vacation Bible School that may be used and posted to social media, website, etc.By checking the box below, you understand and agree to the statement below. *I agreeI understand that Kimberlin Creek Baptist Church will keep my child safe, to the best of their abilities. I give permission to treat my child with the appropriate medical treatment in the event that it is required. I agree to not hold Kimberlin Creek Baptist Church, its staff or volunteers liable for any necessary medical treatment or financial responsibility that may occur.PhoneSubmit