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Westside Baptist Church
Martinez, GA
Vacation Bible School Registration
Westside Baptist Church
261 Flowing Wells Road, Martinez, GA 30907
WildLIVE
July 8-12, 2023 - 9:30AM-12:30PM
Children entering kindergarten through sixth grade only.
Child's Name
*
First Name
Last Name
Child's Birthdate
*
MM
DD
YYYY
Grade Child Enters in the Fall
*
>
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Allergies/Medical Information
Any information we need to know to keep your child healthy
Street Address
*
City/State/Zip
*
Parent/Guardian
*
First Name
Last Name
Your E-mail
Best Contact # during VBS
*
This should be the best contact number for Parent/Guardian
(###)
-
###
-
####
OK to TEXT?
*
YES
NO
Emergency Contact
*
Who should we should contact if parent/guardian cannot be reached?
First Name
Last Name
Emergency Contact's Phone Number
*
(###)
-
###
-
####
OK to TEXT?
YES
NO
Person responsible for picking up child (if other than any listed above)
First Name
Last Name
Phone Number
(###)
-
###
-
####
OK to TEXT?
YES
NO
Submit