2017 Vacation Bible School Registration
 
 

Ready to join us for an exciting week of Vacation Bible School? The dates this year are June 26-30, from 6:30 to 8:30 each evening. Registration and participation are free! Register today using the form below! If you have any questions, please contact us at office@chesterfieldbc.org.
 
Children's Information 
Child #1 Name    Age*    Grade*
Child #2 Name       Age    Grade
Child #3 Name       Age    Grade
Parent / Guardian Information 
Name*
Address*
Email 
Phone*
Alternate Phone 
Home Church 
Medical Information 
Child's Allergies / Medical Needs / Other Information
Emergency Contact Information
Name*
Phone*
Dismissal Information
Name(s) of person(s) who may pick up this child from VBS*
Photo Release: By selecting “Yes” below, I hereby grant to Chesterfield Baptist Church and to its employees, agents and assigns the right to photograph my child and use the photo and/or other digital reproduction of him/her or other reproduction of his/her physical likeness for publication processes, whether electronic, print, digital or electronic publishing via the Internet.*