VACATION BIBLE SCHOOL

Pleasant View Baptist Church 19278 Forest Rd Lynchburg, VA, 24502 United States (map)

Child's Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Guardian's Name(s)

Phone Numbers

Home (H) or Cell (C)

Date of Birth

Last Grade Completed

Medical Information (Include Allergies)

Emergency Contact Name & Numbers

Who is permitted to pick up your child?

Do you attend Sunday School? If so, where?

Do we have permission to photograph your child?

Do we have permission to use the photograph for promotional purposes?