Vacation Bible School Registration

2600 Virginia St, Baytown, TX. 77520 JUN 1-5 5:00pm to 7:30pm
Registration
Student Name

First NameLast Name
Age
Gender
Are you a
Church You Attend
Parent/Guardian Information
Guardian Name

First NameLast Name
Cell Number
Format: (000) 000-0000.
E-mail
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Does the Student have any allergies, chronic illness, or medical conditions? If yes, please describe.
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Format: (000) 000-0000.
Person Dropping off student

First NameLast Name
Drop off vehicle description
or Church Van
Person Picking up student

First NameLast Name
Pick up vehicle description
or Church Van
Take Kids Photo
CHILD CONDUCT

I understand that for the safety of the children and volunteers, certain regulations will be upheld. By signing this document, I agree that m child must accept and obey all rules and requirements governing conduct during VBS and VBS related trips or activities. It is understood that VBS may disallow any child further participation in VBS and VBS related activities if it is determined that they are in violation of these standards.

LIABILITY RELEASE

I understand that El Buen Pastor and its volunteers shall not be held liable for youth who are against the advising of parental/youth volunteers and may not leave the grounds without appropriate supervision or permission.

MEDICAL RELEASE:

I give permission for the VBS staff to administer basic first aid to my child in the event of an injury. I understand that the VBS staff will contact emergency services in the event of a significant emergency and all expenses for such emergency services will be paid by me.

PHOTO RELEASE:

I hereby Grant El Buen Pastor the permission to copyright and use of photographs/videos taken at VBS of my child in any manner or form for any purpose. I wave any right that I may have to inspect or approve the finished product or written copy that may be used in or the use to which it may be applied. I give permission for my child to attend Break Rock Beach-VBS. I understand the information I get for this registration will only be used by El Bueno Pastor for registration purposes.
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.
Signature
Date

MonthDayYear
Date
Should be Empty:

2600 Virginia St, Baytown, TX. 77520 JUN 1-5 5:00pm to 7:30pm

Registration