Child's Name *
Child's Name
Last school grade completed
Parent's Name *
Parent's Name
Address *
In Case of Emergency Who Do We Call *
In Case of Emergency Who Do We Call
Phone *
Van Pickup *
Does your child need to be transported to and from VBS?
Is Van Pickup Location the Same as Address Above
If "NO" provide address below
Van Pickup Address
Van Pickup Address
By pressing submit, you as a parent or guardian, authorize First Baptist Church of De Queen to allow your son/daughter to participate in all activities in either church facilities or off-property locations and will not hold First Baptist Church of De Queen liable for the actions of individuals at the activities. I also release my child to be picked up and transported to the church and/or off properties and to be photographed and videoed for archive or program purposes. Please be aware that we will not allow fighting, swearing, disruptions or public displays of affection. Each individual must obey and respect the leaders and volunteers. Breaking these rules is grounds for your son/daughter to be sent home immediately.