Southwood Baptist

VBS 2017 Online Registration

Come into the church office or LPDN office to purchase your Maker Fun Factory CD for $5 before VBS starts!

Child's Last Name*

Child's First Name*

Child's Age*

Last Grade Completed*

Street Address*



Zip Code*

Mother's Full Name*

Daytime Phone*

Cell Phone*

Father's Full Name*

Daytime Phone*

Cell Phone*


Home Church (if any)(if none, type NONE)*

Name of Emergency Contact*

other than parents

Emergency Contact Phone Number*

Relationship to child*

Allergies or other medical conditions*
(please type NONE if child doesn't have any allergies)

Name of ONE friend with whom you are requesting placement
(please type NONE if you have no preference)

On occasion, children are photographed during their activities. Photos are to be used in an in-house power point presentation. Registration implies consent for photos.