Child's Name (Required)
Child's Age (Required)
Child's Birthdate (Required)
Grade Entering (Required)
Child's Street Address (Required)
Child's City, State, and Zip Code (Required)
Parent(s) Name (Required)
Your Email (Required)
Your Primary Phone Number (Required)
Emergency Contact Name (Required)
Emergency Contact Phone (Required)
Allergies or Other Medical Conditions
Name of Home Church if Applicable
Promotional Consent (Response Required)
The undersigned does also hereby give permission for any photos of our (my) child to be used in promotional materials and/or in the Hamburg Bible Church website (www.hamburgbiblechurch.org), understanding that no names or personal information will be used. Indicate "Permission Given" or "Permission Not Given"
By typing my name below, I attest that I am the parent of legal guardian who wishes to register this child for VBS at Hamburg Bible Church.