Registration | 60th Street Baptist

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2023 VBS REGISTRATION

STUDENT'S NAME

GENDER

MALE

FEMALE

DATE OF BIRTH

AGE

PARENT/GUARDIAN NAME

RELATIONSHIP

ADDRESS [INCLUDE CITY, STATE, ZIP]

PHONE NUMBER

EMAIL

ALLERGIES/MEDICAL CONDITIONS

EMERGENCY CONTACT

RELATIONSHIP

HOME PHONE NUMBER

CELL PHONE NUMBER

OTHER PEOPLE AUTHORIZED TO PICK UP CHILD

THANKS FOR REGISTERING

ssmbcoffice@gmail.com

(727)541-2202

©2023 by 60th Street Baptist Church

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