2016 Vacation Bible School
Registration: Berna Miller

Vacation Bible School  Registration Form

July 17-21, 2016 6:30-8:30pm

First Baptist Church of Mandan 1100 Collins Avenue, Mandan

Children must be going into Kindergarten through 6th grade        Please complete a form for each child and adult

 

Child/Adult’s Name (Last)_______________________________(First)  _______________________

 Parent/Guardian Names ____________________________________________________________

Address _______________________________(City, State, Zip)_____________________________

Mailing Address (if different) ________________________________________________________

Contact Information

Home ______________________­­­­­­_______  Work _______________________________________

Cell ______________________ E–mail _______________________________________________

Age Information

Birth date _________________________   Last grade completed in school _____________________

Medical Information

Medical or other information we need to know. (Please include any food allergies.)

________________________________________________________________________________

________________________________________________________________________________

Emergency Contacts

Name_________________ Phone #____________Name________________ Phone #______________

Dismissal Information   Who may pick up your child at the end of each VBS day? ________________________

Other Information

Do you attend Sunday School? If so where? _________________________________________________

If you are visiting our church, who are you a guest of? __________________________________________

May we have permission to photograph your child?  Yes    No

May we have permission to use your child’s photograph for the purpose of promotion?  Yes   No

 

Signature of Parent/Guardian_________________________________  Date______________________

 
 

For information, registration and transportation, contact

John or Berna Miller, 701-663-6232

or bernamiller@bis.midco.net

 Return completed form(s) to

FBC Mandan, c/o John Miller, 1103 6th St NW, Mandan ND 58554,

or bring it with you to the first night of Vacation Bible School.

 

 

 

 

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