Language
English (US)
WILD WEST - 6:30pm to 8:00pm -June 11, 12, 13, 14 2023 - VBS Registration Form
730 Willow Rd, Hendersonville, NC 28739 / WHVL.org / 828-692-6607
Child Information
Please Submit for Each Child Attending 2023 VBS at WHVL.
Child's Name
*
First Name
Last Name
Child's Birth Date
*
January
February
March
April
May
June
July
August
September
October
November
December
Month
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Last Grade Completed
*
Please Select
Pre-K
Kindergarten
1-4
5-8
9-12
Does the child attend Sunday school anywhere?
*
Yes
No
Where?
Medical or other information we may need to know about the child (including food allergies).
*
Child Release Information
Parent/Legal Guardian Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Names of Persons to which the child (children) may be released to each night after VBS (Please provide at least two (2)
*
First Name
Last Name
Full Name
*
First Name
Last Name
Full Name
First Name
Last Name
Are there any persons to which the child (children) may NOT be released to?
*
Yes
No
Child may NOT be released to?
Emergency Contact 1
*
First Name
Last Name
Emergency Contact 1 Phone Number
*
-
Area Code
Phone Number
Emergency Contact 2
First Name
Last Name
Emergency Contact 2 Phone Number
-
Area Code
Phone Number
Date Form Submitted for Registration
*
-
Month
-
Day
Year
Date
Media Release
Press Submit Button to Complete Registration.
By clicking the box below, I hereby Give Permission for photographs and/or video in which my child appears in to be used by West Hendersonville Baptist Church in printed and/or electronic media, including the church's website.
*
I Agree
I Do Not Agree
Submit
Should be Empty:
Now create your own Jotform - It's free!
Create your own Jotform