North Shore Community Baptist Church
Vacation 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: