2025 VBS Registration Form (Please fill out one form PER child)

VBS Registraion Form (Please fill out one form PER child)
VBS @ Liberty MBC is July 26th from 8:30-2:30pm for children age 2 - 6th grade (based on grade just completed)

Each volunteer at Liberty has gone through an extensive background check to insure the safety of each child here. You can relax knowing their safety is our top priority! We will provide snacks, drinks, and lunch for each child, so it is very important that you list any food allergies on the registration form. VBS will end at 2:30pm, so please be here to pick up your child/children at that time (unless they are riding home on the Church van). We will NOT release your child/children to anyone other than who is listed on the bottom of the registration form. If there is a change to who will pick up your child/children, please call or text the VBS Director, Stacy Pickard, at 214-592-6416 before VBS is over.
Child's Name*

First NameLast Name
Child's Age*
Grade just completed*
Please list any allergies that your child has. We are serving snacks and lunch, so this is important! If your child has no allergies, please put N/A.*
Permission to photograph*
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Emergency Contact Name(If we are unable to reach YOU)*

First NameLast Name
Emergency Contact's Phone Number *
Please enter a valid phone number.
Will be picked upNeeds to be driven home on the church van
If your child is being picked up after VBS (not being transported on Liberty's church van) please list the name of who will be picking up your child. We will NOT release your child to anyone other than who is listed here. If there is a change in this before VBS is over, please text VBS Director, Stacy Pickard at 214-592-6416 to notify us of this change. *

First NameLast Name
Liberty Missionary Baptist Church and its Volunteers are collectively designated by the abbreviation “LMBC” throughout this entire form.

I hereby give permission for my child to attend and participate in activities, including, but not limited to, indoor/outdoor recreational activities and supervised water activities sponsored by LMBC (“LMBC Activities).

I hereby authorize LMBC to call for emergency transport to an emergency facility for medical treatment in the event of an emergency in which neither the parent/legal guardian nor the Emergency Contact can be reached.

The undersigned parent/legal guardian shall be liable and agrees to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child pursuant to this authorization.

Should it be necessary for my child to return home due to medical reasons or otherwise, the undersigned agrees to and shall assume all transportation costs.

I, in both my personal capacity and as parent/legal guardian of this child, hereby release, forever discharge and agree to hold harmless LMBC its directors, employees, volunteers, as well as property damages and expenses, of any nature whatsoever which may be incurred by the undersigned adult and the child/participant that occur while said child is participating in LMBC Activities.

Furthermore, I and on behalf of my child, if under the age of eighteen (18) years, hereby assume all risk of personal injury, sickness, death, damage and expenses as a result of participating in LMBC Activities.

Further authorization and permission is hereby given to LMBC to furnish necessary transportation (if applicable) and food (I have been given the opportunity to notate any food allergies) for this participant.

The undersigned further hereby agrees to hold harmless and indemnify LMBC, its directors, volunteers, employees, and agents for any liability sustained by LMBC as the result of the negligent, willful, or intentional acts of said child, including expenses incurred attendant thereto.

The medical consent and liability waiver provisions hereof shall remain in full force throughout the 2025 activity year and in effect until written notice of revocation or withdrawal is received by LMBC at its office at 5944 Franklin Branch Rd McKinney, TX 75071. It is the responsibility of the parent/legal guardian to notify LMBC of any changes in medical condition, guardianship, address or telephone change in writing to the address provided in this paragraph.
I have read the above statements and agree. Signature*
Should be Empty:

VBS Registraion Form (Please fill out one form PER child)

VBS @ Liberty MBC is July 26th from 8:30-2:30pm for children age 2 - 6th grade (based on grade just completed)