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Participant Registration

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First Baptist Church Tupelo

Location

300 North Church St.

Tupelo, MS 38804

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Contact Kim Smith:

662-842-1327

ksmith@fbctupelo.org

First, Tell Us About Yourself:

Parent Information

Please Note: Only those who have completed 1st-6th Grade can register for VBS! Continue below to complete your child's registration.

PHOTOGRAPHY RELEASE: By completing the Registration Form for my child, I give my permission for my son/daughter to be photographed for promotions and social media.

Last Name

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First Name

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Address 1

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Address 2

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City

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State/Province

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ZIP/Postal Code

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Contact Phone 1

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Parent/Guardian 2

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Contact Phone 2

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Emergency Contact Name

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Emergency Contact Relationship

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Emergency Contact Phone

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Please list anyone that can pick up your child:

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Click here for your FREE Friends With God Kids Activity Pack

By checking the box you will be emailed your Free Friends With God Kids Activity Pack.

You are also agreeing to receive emails about family resources from Lifetree. You can unsubscribe at any time. We value your privacy. Your information will not be shared with a third party. Lifetree is a division of Group Publishing, the creators of Group VBS and other faith-building resources. Click to learn more about Lifetree.

Tell Us About Your Participant

First Name

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Last Name

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Grade Leaving

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Gender

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Date Of Birth

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Allergies

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Medical Concerns

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Comments

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