top of page

About
Ministries
- Youth Group Waiver
Contact

Easter 2022.jpg

Village Baptist Church

Health declaration

Please fill out the following form.

First name

Last name

Email*

Date of birth

Month

Day

Year

Have you been hospitalized in the last 12 months?

No

Yes

Are you suffering from a medical condition, illness or injury?

No

Yes

If you answered yes to any of the questions above, please supply additional information.

Initials*

I declare that the info I’ve provided is accurate and complete.

© 2024 by VillageBaptistChurch. Proudly created with Wix.com

bottom of page