McQueeney Baptist Church Backyard VBS Registration
Please fill out this form and click submit.
Participant's Name
*
Preferred Name for Name Tag
Parent/Guardian Name
*
Address
*
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Primary Phone
*
Email
*
This address will receive a confirmation email
Birthday
*
Last Grade Completed
*
Allergies, Medical, & Special Needs:
Emergency Contact Name (1)
*
Emergency Contact Phone (1)
*
Emergency Contact (2)
Emergency Contact Phone (2)
Authorized Pickup #1
*
Authorized Pickup #2
Authorized Pickup #3
Authorized Pickup #4
Are you a member of this church?
*
Please select one option.
Yes
No
Guest of:
Do you attend church?
*
Please select one option.
Yes
No
If so, where?
May we have permission to photograph your child?
*
Please select one option.
Yes
No
May we have permission to use your child's photograph in church publications?
*
Please select one option.
Yes
No
T-Shirt Size
*
Comments:
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