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Participant Registration

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Registro en Español

Parkway Place Baptist Church

Location

300 Parkway Place Drive

Little Rock, AR 72211

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Contact Stephanie Habenicht:

501-224-3003

stephanie@parkwayplace.church

First, Tell Us About Yourself:

Parent Information

Please note this first form is for Parent information. You will be able to register more than one child.

First Name

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Last 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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Country

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Contact Phone 1

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Text Message Phone

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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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Alternate Pickup Name

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Alternate Pickup Phone

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Home Church Affiliation

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Comments

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Are you registering a nursery or preschool aged child? Please note that if you answer YES you are also agreeing to have and adult on site during VBS.

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Photography Release: By checking YES you give Parkway Place Church permission to post photos of your child on our website and social media accounts.

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Please list the names of any children that you are registering that are foster children.

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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

Please give us as much information as possible on each child. This helps us best serve them while they are with us.

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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Shirt Size

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Allergies

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Medical Concerns

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Do you have friends you would like to be placed with? We will do our best to group selected friends together in the same crew, but we cannot promise all requests will be possible.

Friend 1 First Name

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Friend 1 Last Name

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Friend 2 First Name

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Friend 2 Last Name

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Comments

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Help us get to know your child better. Please check any box that describes your child:

Multiple selections are allowed.

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Please add any details to descriptions you checked on the previous question here.

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