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VBS 2023: DRIVEN
JUNE 19-23, 2023 - 6:00 PM - 9:00 PM
8
Questions
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1
Please enter your FULL NAME below
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First Name
Last Name
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2
Please enter your EMAIL ADDRESS
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This field is required for you to receive any future communications
example@ebcjoppa.org
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3
What is your primary PHONE NUMBER?
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This number will be used to contact you in case of questions, changes, emergencies, etc.
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4
Will other people be attending this event with you?
*
This field is required.
Husband, wife, children, friend, etc
YES
NO
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5
Please fill-in the following if others will be attending service with you
First & Last Name
Age
Relationship
Attendee 1
Row 0, Column 0
Child (17 & under)
Adult (18+)
Child (17 & under)
Adult (18+)
Row 0, Column 1
Husband
Wife
Father
Mother
Son
Daughter
Brother
Sister
Extended Family
Friend
Husband
Wife
Father
Mother
Son
Daughter
Brother
Sister
Extended Family
Friend
Row 0, Column 2
Attendee 2
Row 1, Column 0
Child (17 & under)
Adult (18+)
Child (17 & under)
Adult (18+)
Row 1, Column 1
Husband
Wife
Father
Mother
Son
Daughter
Brother
Sister
Extended Family
Friend
Husband
Wife
Father
Mother
Son
Daughter
Brother
Sister
Extended Family
Friend
Row 1, Column 2
Attendee 3
Row 2, Column 0
Child (17 & under)
Adult (18+)
Child (17 & under)
Adult (18+)
Row 2, Column 1
Husband
Wife
Father
Mother
Son
Daughter
Brother
Sister
Extended Family
Friend
Husband
Wife
Father
Mother
Son
Daughter
Brother
Sister
Extended Family
Friend
Row 2, Column 2
Attendee 4
Row 3, Column 0
Child (17 & under)
Adult (18+)
Child (17 & under)
Adult (18+)
Row 3, Column 1
Husband
Wife
Father
Mother
Son
Daughter
Brother
Sister
Extended Family
Friend
Husband
Wife
Father
Mother
Son
Daughter
Brother
Sister
Extended Family
Friend
Row 3, Column 2
Attendee 5
Row 4, Column 0
Child (17 & under)
Adult (18+)
Child (17 & under)
Adult (18+)
Row 4, Column 1
Husband
Wife
Father
Mother
Son
Daughter
Brother
Sister
Extended Family
Friend
Husband
Wife
Father
Mother
Son
Daughter
Brother
Sister
Extended Family
Friend
Row 4, Column 2
Attendee 6
Row 5, Column 0
Child (17 & under)
Adult (18+)
Child (17 & under)
Adult (18+)
Row 5, Column 1
Husband
Wife
Father
Mother
Son
Daughter
Brother
Sister
Extended Family
Friend
Husband
Wife
Father
Mother
Son
Daughter
Brother
Sister
Extended Family
Friend
Row 5, Column 2
Attendee 7
Row 6, Column 0
Child (17 & under)
Adult (18+)
Child (17 & under)
Adult (18+)
Row 6, Column 1
Husband
Wife
Father
Mother
Son
Daughter
Brother
Sister
Extended Family
Friend
Husband
Wife
Father
Mother
Son
Daughter
Brother
Sister
Extended Family
Friend
Row 6, Column 2
Attendee 1
Attendee 2
Attendee 3
Attendee 4
Attendee 5
Attendee 6
Attendee 7
First & Last Name
Row 0, Column 0
Age
Child (17 & under)
Adult (18+)
Child (17 & under)
Adult (18+)
Row 0, Column 1
Relationship
Husband
Wife
Father
Mother
Son
Daughter
Brother
Sister
Extended Family
Friend
Husband
Wife
Father
Mother
Son
Daughter
Brother
Sister
Extended Family
Friend
Row 0, Column 2
First & Last Name
Row 1, Column 0
Age
Child (17 & under)
Adult (18+)
Child (17 & under)
Adult (18+)
Row 1, Column 1
Relationship
Husband
Wife
Father
Mother
Son
Daughter
Brother
Sister
Extended Family
Friend
Husband
Wife
Father
Mother
Son
Daughter
Brother
Sister
Extended Family
Friend
Row 1, Column 2
First & Last Name
Row 2, Column 0
Age
Child (17 & under)
Adult (18+)
Child (17 & under)
Adult (18+)
Row 2, Column 1
Relationship
Husband
Wife
Father
Mother
Son
Daughter
Brother
Sister
Extended Family
Friend
Husband
Wife
Father
Mother
Son
Daughter
Brother
Sister
Extended Family
Friend
Row 2, Column 2
First & Last Name
Row 3, Column 0
Age
Child (17 & under)
Adult (18+)
Child (17 & under)
Adult (18+)
Row 3, Column 1
Relationship
Husband
Wife
Father
Mother
Son
Daughter
Brother
Sister
Extended Family
Friend
Husband
Wife
Father
Mother
Son
Daughter
Brother
Sister
Extended Family
Friend
Row 3, Column 2
First & Last Name
Row 4, Column 0
Age
Child (17 & under)
Adult (18+)
Child (17 & under)
Adult (18+)
Row 4, Column 1
Relationship
Husband
Wife
Father
Mother
Son
Daughter
Brother
Sister
Extended Family
Friend
Husband
Wife
Father
Mother
Son
Daughter
Brother
Sister
Extended Family
Friend
Row 4, Column 2
First & Last Name
Row 5, Column 0
Age
Child (17 & under)
Adult (18+)
Child (17 & under)
Adult (18+)
Row 5, Column 1
Relationship
Husband
Wife
Father
Mother
Son
Daughter
Brother
Sister
Extended Family
Friend
Husband
Wife
Father
Mother
Son
Daughter
Brother
Sister
Extended Family
Friend
Row 5, Column 2
First & Last Name
Row 6, Column 0
Age
Child (17 & under)
Adult (18+)
Child (17 & under)
Adult (18+)
Row 6, Column 1
Relationship
Husband
Wife
Father
Mother
Son
Daughter
Brother
Sister
Extended Family
Friend
Husband
Wife
Father
Mother
Son
Daughter
Brother
Sister
Extended Family
Friend
Row 6, Column 2
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6
What days will you be joining us?
*
This field is required.
Please select which days you will be attending our VBS event
Monday, June 19, 2023
Tuesday, June 20, 2023
Wednesday, June 21, 2023
Thursday, June 22, 2023
Friday, June 23, 2023 (FAMILY NIGHT)
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7
Please list someone to contact in the event of an emergency
Full Name
Contact Number
Emergency Contact
Row 0, Column 0
Row 0, Column 1
Emergency Contact
Full Name
Row 0, Column 0
Contact Number
Row 0, Column 1
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8
Do you have any underlying health conditions that we should be aware of?
This is OPTIONAL. You are disclosing this information at your own discretion. Any information you provide will not be shared
YES
NO
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9
If you answered yes on the previous page, please list any underlying health conditions that we should be aware.
This is OPTIONAL. You are disclosing this information at your own discretion. Any information you provide will not be shared
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10
DISCLAIMER
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This field is required.
Ebenezer Baptist Church, Ebenezer Baptist Church Inc., and all affiliates will not be responsible in any manner for any risks related to COVID-19 in connection with in-person events resuming. By checking below, you understand that Ebenezer Baptist Church and Ebenezer Baptist Church Inc. have undertaken reasonable steps to lessen the risk of transmission of COVID-19 at all in-person events. You also acknowledge that you are returning to in-person events at your own risk and hereby release Ebenezer Baptist Church, Ebenezer Baptist Church Inc., and its current officers, employees, members, volunteers, representatives, and affiliates from any and all liabilities, claims, litigation, causes of action of any nature which may be incurred, directly or indirectly, now or in the future, in any way related to COVID-19.
I have read and understood the above disclaimer. I acknowledge that I am voluntarily returning to in-person events and release Ebenezer Baptist Church and its affiliates from all legal responsibilities related to COVID-19.
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