CHILD'S NAME       ADDRESS 


DATE OF BIRTH                                  GRADE - FALL 2019   


PHONE         TYPE             T-SHIRT SIZE 


EMAIL ADDRESS   __parser__boolean_attribute_value__parser__


PARENTS/GUARDIANS/RELATIVES   Note:  Please list all individuals authorized to pick up your child.  Emergency contact will be made in the order listed below.


      PHONE   

      PHONE                                            

      PHONE   

      PHONE   


PLEASE LIST ANY ALLERGIES OR HEALTH CONCERNS

     


HOME CHURCH              


HOW DID YOU HEAR ABOUT BATH BAPTIST VBS?