CHILD'S NAME *

First Name

Last Name

CONTACT NAME *

Your name...

First Name

Last Name

ADDRESS *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

CONTACT PHONE *

(###)

###

####

CHILD'S BIRTH DATE *

MM

DD

YYYY

EMERGENCY CONTACT *

List an emergency contact other than what's listed above.

First Name

Last Name

EMERGENCY PHONE *

(###)

###

####

PHOTOGRAPHY

May we have permission to photograph your child during VBS attendance?

yes

no

MEDIA USAGE

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

yes

no

FAITH BIBLE FELLOWSHIP

Would you like more information about Faith Bible Fellowship?

Yes, we're currently searching for a church home.

No, we have a church home already.

We currently have a church home, but love what we've seen in FBF. Please contact me.