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FBCPC VBS 2024
SCUBA diving into friendship with God
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Child Registration Form (for children 4-yrs-old through 6th grade)
First Baptist Church of Pearl City
1445 Hoolaulea Street, Pearl City, HI 96782 ~ (808) 455-2011 ~ office@fbcpearlcity.org
Child #1
Name:
Your answer
Child #1
Birthdate:
MM
/
DD
/
YYYY
Child #1
Allergies, health concerns, or other important info:
Your answer
Child #1
School grade completed in May/June 2024:
Your answer
Child #1
If you would like to purchase a T-shirt ($6) for your child, please select size:
*Please make payment at the VBS registration table on Sundays or on the 1st night of VBS
Youth XS
Youth S
Youth M
Youth L
Adult S
Other:
Clear selection
Child #1
Will attend VBS on (please check all dates that apply):
May 31
June 7
June 14
June 21
June 28
Home address (please include City, State, Zip):
Your answer
Email address:
Your answer
Primary Parent/Guardian Name:
Your answer
Primary Parent/Guardian Cell Number:
Your answer
Secondary Parent/Guardian Name:
Your answer
Secondary Parent/Guardian Cell Number:
Your answer
Emergency Contact - please include relationship to child(ren):
Your answer
Emergency Contact Cell Number:
Your answer
FBCPC will be taking photos and videos of VBS activities to be used for the end-of-summer video montage, website, newsletter, and other promotional purposes
I grant permission for pictures of my child(ren) to be used
I do NOT grant permission for pictures of my child(ren) to be used
Clear selection
Child #2
Name:
Your answer
Child #2
Birthdate:
MM
/
DD
/
YYYY
Child #2
Allergies, health concerns, or other important info:
Your answer
Child #2
School grade completed in May/June 2024:
Your answer
Child #2
If you would like to purchase a T-shirt ($6) for your child, please select size:
*Please make payment at the VBS registration table on Sundays or on the 1st night of VBS
Youth XS
Youth S
Youth M
Youth L
Adult S
Clear selection
Child #2
Will attend VBS on (please check all dates that apply):
May 31
June 7
June 14
June 21
June 28
Child #3
Name:
Your answer
Child #3
Birthdate:
MM
/
DD
/
YYYY
Child #3
Allergies, health concerns, or other important info:
Your answer
Child #3
School grade completed in May/June 2024:
Your answer
Child #3
If you would like to purchase a T-shirt ($6) for your child, please select size:
*Please make payment at the VBS registration table on Sundays or on the 1st night of VBS
Youth XS
Youth S
Youth M
Youth L
Adult S
Clear selection
Child #3
Will attend VBS on (please check all dates that apply):
May 31
June 7
June 14
June 21
June 28
Any additional information that you would like to share about your child(ren) regarding their VBS participation:
Your answer
Submit
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