Official Sonrise National Park Registration

VBS Dates: June 18 - June 22, 2012

Times: 6:00 - 8:00 pm

Bus Pickup is available - please note below
Child Registration

Please fill out one form per child.
Participant Information
Participants Name

First NameLast Name
Participant is a
Birth Date

MonthDayYear
Age at time of VBS
Grade Entering in the Fall
Parent Information
Parent 1 Name

First NameLast Name
Parent 1 Phone

Area CodePhone Number
Parent 2 Name

First NameLast Name
Parent 2 Phone

Area CodePhone Number
Parent Email
Medical & Emergency
Allergies
None, Nuts, Peanuts, Medicines, etc.
Medical Conditions
None, Lactose intolerant, Asthma, etc.
Emergency Contact Name

First NameLast Name
Emergency Contact Relationship
Parent, Grandparent, Aunt, Family Friend, etc.
Emergency Contact Phone

Area CodePhone Number
Alternate Pickup
Alternate Pickup Name

First NameLast Name
Alternate Pickup Phone

Area CodePhone Number
Alternate Pickup Relationship
Parent, Grandparent, Aunt, Family Friend, etc.
Miscellaneous
Did you attend VBS last year?
If bus transportation is needed, list major cross streets here
Additional Information
Please tell us any additional info we may need to know.
I understand that as a participant in Belmont Baptist Church - Tampa VBS, my child may be photographed or videotaped during VBS events. I also understand that these may be used in presentation & promotional materials through a variety of media; including, but not limited to the church website, newsletters, bulletin, flyers, etc. I release Belmont Baptist Church - Tampa from any and all liability.
Photo Release
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Child Registration

Participant Information

Parent Information

Medical & Emergency

Alternate Pickup

Miscellaneous