Holly Hills Baptist Church - Powhatan, Virginia

We look forward to enjoying our 2010 Vacation Bible School together with you. To help us prepare for this event, we ask that you complete the short form below. This will enable us to have adequate resources available to ensure an enjoyable and profitable time for your children.

Child's Name: *
Age: *
Grade: *	[Last Grade Completed]
Address: *
City/St/Zip: *
Phone: *	[Format: (xxx) xxx-xxxx]
Email:	[if available]
Parent/Guardian: *
Emergency Contact: *
Phone #: *	[Format: (xxx) xxx-xxxx]
Allergies/Concerns:
Attend Holly Hills: *	Yes No
Attend Another Church: *	Yes No
Invited By:	[leave blank if self]

By submitting this online registration you acknowledge the following:

EMERGENCY INFORMATION & AUTHORIZATION

While on the property of Holly Hills Baptist Church and during the course of our 2010 VBS program: In case of accident or emergency, I, the parent or guardian of the above named child, give my consent for any licensed physician, dentist or emergency personnel to administer treatment deemed necessary prior to my arrival.

42,651 Visits Since 09/05/2004