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Rock Springs Baptist Church
2155 Rock Springs Road
Greenbrier, TN 37073
PH: (615) 643-0772
FAX: (615) 643-0779
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2011 Vacation Bible School Registration Form

Rock Springs Baptist Church 2155 Rock Springs Rd Greenbrier, TN 37073

Please complete if you are enrolling your child (ages 3 yrs - 6th grade) in our Vacation Bible School to held June 17-21, 2013. Please fill out a separate form for each child you are enrolling.

* Required Fields

*Child's First Name:
*Child's Last Name:
*Parents/Guardian's Name:
Child's Email Address:
*Parent/Guardian (Your) Email Address:
*Street Address:
*City:
*State:
*Zip:
*Home Phone:
Your Work Phone:
Your Cell Phone:
*Child's Birthdate:
Age of Preschooler (by July 2, 2014):
Last grade completed prior to VBS (Grades 1-6):
*Medical or other information we need to know. Please include any allergies.:
Does child go to Sunday School anywhere? If so, where?:
*In the event of an emergency, whom do we call? Please give two contact names and telephone numbers where they may be reached.:
*Who may pick up this child at the end of VBS each evening? Please give names of anyone who you think will need to pick up your child.:
By registering your child for Club VBS, you are giving permission for your child to be included in photographs or video taken. This also gives your permission for photos to be uploaded to our website.
*Authentication:
*1 + 7 =	Enter the correct answer to the math question.
Please click the Send button only once.

Rock Springs Baptist Church

Reaching Out with Living Water

2011 Vacation Bible School Registration Form