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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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2012 Club VBS Registration

Please complete if you are enrolling your child (ages 3 yrs - 6th grade) in our Club Vacation Bible School to be held July 14-18, 2013. Please fill out a separate form for each child you are enrolling.

Sunday, July 14 Time: 5:30 - 7:30 p.m.

Monday - Thursday, July 15-18 Time: 6:00 - 8:00 p.m.

Location: 2155 Rock Springs Rd Greenbrier, TN 37073

* Required Fields

*Child's Name:
Child's Email Address:
*Parents/Guardian's Name:
*Parent/Guardian (Your) Email Address:
*Address:
*Home Phone:
Your Work Phone:
Your Cell Phone:
*Birthdate:
Age of Preschooler (as of July 14, 2013):
Last grade completed prior to Jungle Jaunt (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 VBS or 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 uploaded to our website.
Authentication:
6 + 1 =	(Required) Enter the correct answer to the math question.
Please click the Send button only once.

Rock Springs Baptist Church

Reaching Out with Living Water

2012 Club VBS Registration