Online Beach Blast Weekend Adventure Registration

July 15-17 - 9am-2pm

Please fill out the following blanks completely to register your child for a Beach Blast! Please note that on the first day of the Beach Blast Weekend Adventure, you will have to additionally sign a medical and liability release form at drop-off.

Child's Name:

Parent/Guardian's Name:

Parent/Guardian's Email:

Street Address:

City:

Zip:

Home Phone:

Cell Phone (Mom):

Cell Phone (Dad):

Emergency Contact Name:

Emergency Contact Phone:

Beside Above-Listed Parent/Guardian, who else may pick up your child at the end of each day (List all names! We will check IDs if they do not have the pick-up card):

Child's Birth Date:

Child's Age (As of July 15, 2011):

Grade Last School Year:

Child's Gender:

Name of Church Your Family Regularly Attends:

Special Medical/Allergy Information:


** By clicking "Submit", you will register your child for First Baptist's Vacation Bible School  and you agree to allow First Baptist to use your child's picture for promotional purposes.

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