Vacation Bible School Registration

Ages	4 - 12 years old
Dates	August 10 - 13
Time	6:30 PM - 8:00 PM
Location	Old Fashion Baptist Church 5003 Wynne Ave Butte, MT
Contact	(406) 494-5028

Student Information

First Name

Please enter student first name

Last Name

Please enter student last name

Grade

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Birthday

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Does the student have any allergies?

Yes

Allergies

Please enter student allergies

Does the student have any dietary restrictions?

Yes

Dietary Restrictions

Please enter student dietary restrictions

Has the student attended VBS in the past?

Yes

Does the student currently ride the bus or van?

Yes

Parent/Guardian Information

First Name

Please enter parent/guardian name

Last Name

Please enter parent/guardian name

Address Line 1

Please enter parent/guardian address

Address Line 2

City

Please enter parent/guardian city

State *

-- Select a State --

Please enter parent/guardian state

Zip

Please enter parent/guardian zip

Home Phone

Mobile Phone

Please enter parent/guardian mobile phone (must be 10 digits)

Work Phone

Please enter parent/guardian email

Emergency Contact Information

Same as Parent/Guardian

First Name

Last Name

Phone

Notes

Transportation needed, comments, concerns, etc.

Vacation Bible School Registration

Student Information

Parent/Guardian Information

Emergency Contact Information

Complete!

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