Mystery Island VBS 2022

Thank you for your interest in MYSTERY ISLAND VBS. Please fill out and submit the below form for every child, from age 3 (potty trained) to 6th grade you would like to register for MYSTERY ISLAND VBS.

Child's Name(required)

Date of Birth(required)

Grade Completed(required)

Address(required)

Parent/Guardian(required)

Phone Number(required)

Email(required)

Emergency Contact(required)

Relationship to Child(required)

Phone Number(required)

Who can pick up your child?(required)

Name of Home Church

Food Allergies

Medical Concerns or Special Needs

Permission To Use Images and Video

I hereby grant permission for Heritage Baptist Church to record sounds, images, or video of my child while attending this VBS program. I also give permission for Heritage Baptist Church at its sole discretion, to use these sounds, images, or videos in publications (including print, websites, and social media platforms) owned by Heritage Baptist Church in relation to this VBS program.

Parent/Guardian Name

Date

Submit Form

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