Jungle Journey VBS @ Gashland Baptist

Thanks for being interested in Vacation Bible School here at Gashland Baptist Church. VBS runs from June 2nd-6th. 6:00pm - 8:30pm. Please fill out this form and click submit. Questions? Call the church office at 816-436-0031 or email Pastor Ryan at pastornix@gashlandbc.org.

Full Participant Name

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Preferred Name for Name Tag

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Gender

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Please select one option.

Male Female

Birthday (MM/DD/YYYY)

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Last Grade Completed

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Please select one option.

Preschool (3-5 Years Old) Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade

Allergies, Medical, & Special Needs: (Type N/A if None)

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Need Bus Transportation?

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Please select one option.

Yes No

Parent/Guardian Name:

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Address

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Phone

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Email

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This address will receive a confirmation email

Emergency Contact Name (1)

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Emergency Contact Phone (1)

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Relation to Student

*

Emergency Contact Name (2):

Emergency Contact Phone (2)

Relation to Student

Other Authorized Pickup #1

Other Authorized Pickup #2

Other Authorized Pickup #3

Other Authorized Pickup #4

Is there any other information we need to know about your student?

Description

Thanks for being interested in Vacation Bible School here at Gashland Baptist Church. VBS runs from June 2nd-6th. 6:00pm - 8:30pm. Please fill out this form and click submit. Questions? Call the church office at 816-436-0031 or email Pastor Ryan at pastornix@gashlandbc.org.

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