2018 VBS Day Camp Registration: "To Infinity and..."

Name of Child: *

First Name Last Name

Age in July (ages 4-12) *

Birth Date

Month Day Year

*School Grade in Fall: *

*If child is pre-K or K enter 0 into the field.

Sex of Child *

Allergies:

Name of Guardian: *

First Name Last Name

Main Contact Phone Number *

Area Code Phone Number

Alternative Contact Phone Number

Area Code Phone Number

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Email

example@example.com

Would you like to receive email notifications about future family friendly events?

Type a question

READ CAREFULLY :

To complete registration a different person other than the guardian is required as an alternative emergency contact with a different phone number. If this information is not given, your child's space is not held. We appreciate your help in this matter. Your child's safety is our top priority!

Emergency Contact Person: *

Emergency Contact Phone Number: *

Area Code Phone Number

For safety and security we will use a password system for releasing
children from VBS. For a person to take a child they will have to provide
the password established by the adult guardian for that child.

Password for Releasing Child *

Do you give permission for the supervised use of sunscreen by the above named child? *

Do you give permission for the supervised use of bug spray by the above named child? *

Do you give permission for your child to be in a group photo with their group which will be sent home with each child as a keepsake of their VBS time/group? *

Do you give permission for the above named child to appear on social media, First Baptist Church or other affiliated websites, and/or the newspaper *without* their names being mentioned? *

Any additional information or comments:

Liability Release Form

Event: 2022 Summer Camp at First Baptist Church of Narragansett, 305 Kingstown Rd, Narragansett, RI July 25-29, 2022

By signing below, I assume any risk of harm or injury which might occur to the participant due to his/her participation in the event or activity, I release the organization or business named above from all liability, costs and damages which might arise from participation in the above named event or activity.

If the participant is a minor, I agree that the minor has my consent to participate in the event. I further provide my consent for the organization or business named above to seek emergency treatment for the minor if necessary. I agree to accept financial responsibility for the costs related to this emergency treatment.

Guardian Signature (can be signed with mouse, stylus, etc) *

Clear

Guardian Full Name *

First Name Last Name

Date