Hahira First Baptist VBS 2009 Registration Form
June 7, - June 12, 2009
Supper: 5:30 p.m. (Sunday - Thursday)
VBS 6:00 - 8:30 p.m.

* Child's First Name :
* Child's Last Name :
* Child's Age :
* Child's Birth date :
* Enter the last grade this child completed :
Father's First Name :
Father's Last Name :
Mother's First Name :
Mother's Last Name :
* Address :
* City :
* State :
* Zip Code :
Home Phone with area code:
Cell Phone(1) with area code:
Cell Phone(2) with area code:
* E-mail address :
* Emergency Contact Person :
* Emergency Contact Phone Number :
* Are you currently a member of a church?



If yes, church name?
Church Address :
Are you a guest of an HFBC church member?



If yes, who?
Please list any allergies :
* Person (1) authorized to pick up child :
Person (2) authorized to pick up child :
Person (3) authorized to pick up child :
Person(4) authorized to pick up child :
Any additional comments?
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