North Shore Community Baptist ChurchVacation Bible School On-Line Registration
Child's Last Name: First Name:
Date of Birth: 010203040506070809101112 01020304050607080910111213141516171819202122232425262728293031 20032002200120001999199819971996 Entering Grade: K123456 Gender: FM Month Day Year
Street Address:
City: State: ZipCode:
Home Phone: Cell Phone:
Email Address:
Name of Parent or Guardian:
We attend church regularly:
Name of Church:
My Child has attended NSCBC VBS before:
Allergies or Special Needs:
Emergency Contact Information
Contact's Name:
Contact's Relation to Child:
Contact's Phone Number:
Other than parents, who else is authorized to pick up your child each day?
Names of Friends and/or Siblings also attending NSCBC VBS: