Wonder Junction at Shady Grove Baptist Church

Family Information

Address

Street

Street 2

City

State/Province

Postal Code

Parent/Guardian First Name

Parent/Guardian Last Name

Primary Phone

Alternate Phone

Emergency Contact

Relationship to Student

Phone Number

Do you or your children regularly attend a local church?

yes

If so, where Church name and location

May we have permission to photograph your child

yes

May we have permission to use you child's photograph in church publications for the purposes of promotion or video production?

yes

Dismissal Information: (We will dismiss all children each day from the church sanctuary) Who, other than parent/guardian, may pick up your child each day?

Please provide names and contact info in the box below

Register for VBS

at Shady Grove Baptist Church

Family Information

Address

Student Information