Summer Camp Detailed Registration Form

Vacation Bible School Registration

July 27-29, 2022
VBS Participant Information
Child's Name

First Name Last Name
Birth Date

Month Day Year
Grade
Gender

Male Female
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Parent/Guardian Information
Name

First Name Last Name
Phone Number
E-mail
example@example.com
Does the child have any allergies, chronic illness, or medical conditions? If yes, please describe.
Informed Consent and Acknowledgement I hereby give my approval for my child’s participation in any and all activities prepared by Liberty Baptist Church during the selected camp. In exchange for the acceptance of said child’s candidacy by Liberty Baptist Church, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Liberty Baptist Church and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected vacation bible school sessions. In case of injury to said child, I hereby waive all claims against Liberty Baptist Church.
Confirmation BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
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Vacation Bible School Registration