Registration Information

Please enter The Following Information to Register Your child for vacation bible school 2009 at Central Point Baptist Church. This form is for registration. We will not put you on any mailing list and we will not give your name or address to anyone.

* First Name: * Last Name:

*Street Address:

*City: *State: Alabama Alaska Arizona Arkansas California Colorada Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming *Zip Code:

*Age: 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 *School grade just completed: Pre-K Kindergarten 1 2 3 4 5 6 7 8 9 10 11 12

*Home phone Number: cell Number:

*Parent's/Guardian Name:

In case of emergency contact:

*Name:

*Phone Number:

Please list any food or medical allergies:

* email Address:

do you attend sunday school?: no yes

if yes, where? :

Questions / Comments

Thank you for Registering with us!