2020 JAXSBC VIRTUAL VBS REGISTRATION Please fill out a form for each child attending VBS this year. Child's Information Question Title * 1. Child's First Name Question Title * 2. Child's Last Name Question Title * 3. Child's Birthdate (month/date/year) Question Title * 4. Grade Completed in Spring 2020 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade PreK (4-5 years) Kindergarten Question Title * 5. Medical/Dietary Considerations No special medical or dietary considerations Asthma Sugar/dye intolerance Peanut allergy Gluten-free Diabetic Other (please specify) Question Title * 6. Children's Shirt Size Youth Small Youth Medium Youth Large Youth XL Adult Small Adult Medium Other - please enter children's t-shirt size needed here if not listed above Parent/Guardian Information Question Title * 7. Parent's First Name Question Title * 8. Parent's Last Name Question Title * 9. Parent's Address (Street, City, Zip) Question Title * 10. Parent's Phone Number Question Title * 11. Parent's Email Question Title * 12. Emergency Contact Person Question Title * 13. Emergency Contact's Relationship to Child Question Title * 14. Emergency Contact's Phone Number Question Title * 15. Authorized for Pick Up Name Name Question Title * 16. Are you interested in volunteering for VBS this year? Yes No Notice of Photography or Video Recording Question Title * 17. When entering a Second Baptist Church event, including Vacation Bible School, you are entering an area where photography, videography, or audio recording may occur. These images, photos, or videos may be published on Second Baptist Church's website or social media pages for promotional purposes, or in other advertising publications. I have read and agree to the Notice of Photography or Video Recording statement. Yes No Register for VBS!