2023 VBS- First Baptist Church

2023 VBS- First Baptist Church

July 10th-13th from 8:30am-12:30pm For children entering k-6th for 2023-24 School Year
Child's Name*

First NameLast Name
M/F*

MaleFemale
Child's Birthdate: Birthdate
Grade your child will be attending the 2023-2024 school year: Grade*
Parent/Guardian Name*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number*
Please enter a valid phone number.
Work Phone Number*
Please enter a valid phone number.
Cell Phone Number*
Please enter a valid phone number.
Parent Email*
example@example.com
Medical Information. Medical or other information we need to know. (Please include food allergies)*
Emergency Contact*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Emergency Contact

First NameLast Name
Phone Number
Please enter a valid phone number.
Dismissal Information: Who may pick up your child and the end of each day?*
Does your child regularly attend church somewhere? If so, where?
If your child is visiting our church, who is he/she a guest of?
I, the parent or legal guardian of my student, consent and give permission for my child
to attend Vacation Bible School July 10-13 at FBC Madisonville..
I understand that personal injury can and may occur to my child, and I hereby
authorize First Baptist Church Madisonville, or another appointed childrens advisor, to seek
and consent to emergency medical attention for my child as needed; and I further
agree to be liable for and to pay all costs incurred in connection with such medical
attention.
I hereby release First Baptist Church Madisonville, its employees, agents and
volunteers, from any and all liability, claims, demands, causes of action and possible
causes of action whatsoever arising out of or related to any loss, damage or injury
(including death) that may be sustained by my child while participating in or traveling
to and from this event.
I give permission for my child to ride in any vehicle designated by First Baptist Church
Madisonville, its employees and adult volunteers, while participating in and traveling to
and from this event. I agree to accept full responsibility, financially or otherwise, for any
damage my child may do to the property of First Baptist Church Madisonville, properties
visited on outing, other’s personal property, or vehicles used for transportation.

I also give permission for my child/children to be photographed for promotional purposes understanding that no personal information will be divulged about my child.
I agree and consent to all of the above stated.
Signature*

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