But God Ministries Jonestown Life Center 316 Main St. Jonestown, MS 38639 2021 Vacation Bible School Registration Child's Name* First Middle Last The name you go by*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Parent Name* First Middle Last Home PhoneCell Phone*Work PhoneEmail Address* Child's Date of Birth* Date Format: MM slash DD slash YYYY Grade Completed*K1st2nd3rd4th5th6thHave you, your child, or anyone else in your household been exposed to COVID-19?*yesnoHave you, your child, or anyone else in your household displayed any symptoms of COVID-19 in the last 14 days?*yesnoHave you, your child, or anyone else in your household been to a high risk area in the last 14 days?*yesnoHave you, your child, or anyone else in your household traveled outside of the country in the last 14 days?*yesnoPlease tell us anything important that we should know about your child:*Emergency Contact InformationEmergency Contact #1*Street Address for Emergency Contact #1*Phone for Emergency Contact #1*Emergency Contact #2*Street Address for Emergency Contact #2*Phone for Emergency Contact #2*Does your child have any allergies or medical conditions that we should be aware of?*Virtual VBS 2020 - July 20-23, 2020Customized VBS kits will be mailed directly to students.Kits will be created according to your child's interests. Please select your child's FIRST choice:*AdventureCreativeFitnessGourmet ChefPerforming ArtsRecreationSecret OpsWacky ScienceKits will be created according to your child's interests. Please select your child's SECOND choice:*AdventureCreativeFitnessGourmet ChefPerforming ArtsRecreationSecret OpsWacky ScienceVBS Liability and Permission FormSignature*Understand that by signing this form you are stating that all the information you have given on this form is true and that you agree with the VACATION BIBLE SCHOOL LIABILITY AND PERMISSION FORM.Date Signed* Date Format: MM slash DD slash YYYY