2009 VACATION BIBLE
SCHOOL REGISTRATION

Twin Lakes Southern Baptist Church
1100 Poplar Dr.
Monticello, IN 47960
574-583-2561
www.twinlakessbc.com

Name Of Child or Children

First Name

Last Name

Sex

Birth Date

Grade Child Will Be In

First Name

Last Name

Sex

Birth Date

Grade Child Will Be In

First Name

Last Name

Sex

Birth Date

Grade Child Will Be In

Your Name

* First Name

* Last Name

* Address 1

* City

* State

* Zip

* Phone

Alternate Phone

* Email Address

* Relationship to Participant(s):

Mother

Father

Guardian

Other

* Emergency Contact

* Phone Number

* Emergency Contact 2

* Phone Number

Does your child have any food allergies? If yes, please list them here.

Child # 1

Child # 2

Child # 3

* Will you allow us to publish a picture of your child as they participate in group activities? This may include Indiana Baptist magazine, our local paper, or on our church website.

* Indicates Response Required