Vacation Bible School Registration
June 15-19 6-8:30 PM
Child's Information
Fill out 1 form per child attending VBS.
Child's Name
*
First Name
Last Name
Child's Birth Date
*
-
Month
-
Day
Year
Date Picker Icon
Grade Last Completed
*
Please Select
Pre-k
K
1st
2nd
3rd
4th
5th
6th
Gender
*
Please Select
Male
Female
Allergies
*
Yes
No
If yes, what is he/she allergic to?
Dietary Restrictions/Needs for your child
Has your child attended a Mt. Alto Baptist Church event in the past year?
*
Yes
No
If yes, which one(s)
*
Church Service
VBS
Fall Festival
Easter Egg Hunt
Any other information you would like us to know about your child.
Parent/Guardian Information
Parent/ Guardian Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do you attend church regularly? (2 or more times per month)
*
Yes
No
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Emergency Contact
If different from Parent/Guardian Information
Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Email
example@example.com
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Permission to photograph and/or video my child.
Please e-sign below
I/We give consent for my/our child to be photographed, videotaped or filmed while participating in activities at or sponsored by Mt. Alto Baptist Church and for those images to be used in publication(s). By attending this public event, and not being individually identified, there will be no reasonable expectation of privacy, intentionally or unintentionally, violated.
*
e-signature
Liability Release: Please e-sign below.
In consideration for allowing my/our child to participate in activities at or sponsored by Mt. Alto Baptist Church, Rome, GA, I/We agree to allow a staff member(s) or volunteer(s) of Mt. Alto Baptist Church to transport my/our child to and from my/our home, or have my/our child transported, to the nearest medical facility in case of emergency or in the event that I/we cannot be reached by phone. I/We understand that there are inherent risks involved in any event, and I/we hereby release Mt. Alto Baptist Church, its employees, its agents, and volunteer workers from any and all liability for any injury, loss, or damage to person or personal property that may occur during the course of my/our child’s involvement with Vacation Bible School. In the event that he/she is injured while attending the event and requires the attention of a doctor, I/we consent to any reasonable medical treatment as deemed necessary by a licensed physician. I/we will be responsible for, and not hold Mt. Alto Baptist Church or individual Mt. Alto Baptist Church Staff member(s) or volunteer(s) worker(s) responsible for, any expenses incurred. I understand that proper and respectful behavior is expected of my/our child.
*
e-signature
Submit
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