What a Mess! Vacation Bible School
St. Paul Missionary Baptist Church - 821 B Street - St. Albans, WV 25177
Children from St. Paul Missionary Baptist Church and the entire surrounding community are invited to join us for a fun week of Free Food, Bible Stories, Crafts, Music, Games & Snacks!
If your child would like to attend, please complete and submit the registration form below by Monday, July 1, 2024. Space is limited. Please email questions to stpaulvbs2024@gmail.com, visit the Frequently Asked Questions Section on the website: www.spmbcvbs2024.com or contact the church at 304.727.1742 on Tuesday through Friday from 9 AM - 2 PM, except major holidays.
Registration Form - Children ages 17 years and younger
This form should be completed by the custodial parent and/or legal guardian of the child to be registered. Please complete one (1) form per child.
Childs' Name
*
First Name
Last Name
Child's Birthdate
-
Month
-
Day
Year
Date
Current Grade of Child
Please Select
Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Current Age of Child
*
Gender of Child
Please Select
Male
Female
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Custodial Parent/Legal Guardian’s Information
Custodial Parent/Legal Guardian's Name
*
First Name
Last Name
Custodial Parent/Legal Guardian's Email
example@example.com or enter N/A if an email address is not available
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone Number
Please enter a valid phone number.
Cell Phone Number
Please enter a valid phone number.
Alternate Phone Number, if applicable
Please enter a valid phone number.
Home Church (if applicable):
Does the child you are registering have a sibling or siblings who will also attend the 2024 What a Mess! Vacation Bible School program at St. Paul Missionary Baptist Church?
Yes
No
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Siblings
Please list the names and ages of all siblings also attending the 2024 What a Mess! Vacation Bible School at St. Paul Missionary Baptist Church, as applicable.
Full Name - Sibling #1
Sibling #1 Age
Full Name - Sibling #2
Sibling #2 Age
Full Name - Sibling #3
Sibling #3 Age
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Allergies and Medical Concerns
Does the child have any allergies?
*
Yes
No
If yes, please describe the child's allergies below. Ex. Allergies to food, seasonal allergies, medication allergies, etc.
Does the child have any medical concerns, physical limitations or restrictions, communication needs, etc.?
*
Yes
No
If yes, please describe the child's medical concerns below. Include any physical limitations or restrictions, communication needs, or anything else that will help us to help your child have the best possible week at VBS.
Family Doctor's Name
*
Family Doctor's Phone Number
*
Please enter a valid phone number.
MEDICAL STATEMENT: In the event of a medical emergency and when a contact cannot be made in a timely manner to me and/or the emergency contact listed, I give my permission for my child(ren) to receive appropriate medical attention. In the event of an unforeseen emergency or any accidents, I release St. Paul Missionary Baptist Church, its employees and volunteers, and all those related to it, from any liability. I have provided emergency contact numbers and am assured that I will be contacted as soon as possible in the event that there is an emergency. I hereby agree to be responsible for payment of all costs and expenses of any health care provider or other person who acts in reliance upon this consent and authorization for treatment.
*
I agree with the Medical Statement
I disagree with the Medical Statement
Custodial Parent/Legal Guardian Signature
*
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Emergency Contacts
Child will only be released to the custodial parent or legal guardian and the individuals listed below. The following people will also be contacted and are authorized to remove the child from the facility in case of illness, accident or an emergency and, if for some reason, the custodial parent or legal guardian cannot be reached.
Emergency Contact #1
*
Full Name
Phone Number
Emergency Contact #2
Full Name
Phone Number
Emergency Contact #3
Full Name
Phone Number
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Transportation
Limited transportation via church bus and/or van is available for the St. Albans, Institute and Dunbar, West Virginia areas. Will the child need transportation to attend the 2024 What a Mess! Vacation Bible School (VBS)?
Yes, my child will need transportation to VBS AND transportation home from VBS. *Please note* The child will be picked up and dropped off at the same address.
Yes, my child will need transportation to VBS, but WILL NOT need transportation home from VBS
No, I will arrange for or provide transportation for my child to and from VBS
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Transportation - Page 2
CHURCH BUS/VAN RULES: Children utilizing church bus and/or van transportation are expected to adhere with bus safety rules (including, but not limited to, no eating or drinking on the bus, no vandalism, remain seated, no fighting, refrain from foul language, etc.). Failure to comply with bus safety rules may result in the child not being permitted to ride the bus. A complete list of rules will be provided 2 weeks prior to the program start date.
Yes, I understand that if my child does not comply with church bus/van rules during the 2024 What a Mess! Vacation Bible School, I may be contacted and my child may not be permitted to ride the church van/bus in the future.
Is your child's Pickup and/or Dropoff Address the same as your Home Address?
Yes, please use the Home Address listed on this form
No, please use the Pickup Address entered below
Please list your child's Pickup and Drop off Address.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Photo Release
PHOTO RELEASE: St. Paul Missionary Baptist Church will, on occasion, take photographs and/or video with audio of the children participating in our programs to publicize and promote the church activities or events. I understand the images may be used in print publications, online publications, presentations, church websites, and social media. I also understand that no royalty, fee, or other compensation shall become payable to me by reason of such use.
*
I DO give permission for my child(ren) to be photographed and/or video recorded with audio for the purpose of promoting St. Paul MBC programs and events.
I DO NOT for my child(ren) to be photographed and/or video recorded with audio for the purpose of promoting St. Paul MBC programs and events.
Custodial Parent/Legal Guardian Signature
*
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Information Attestation and Permission to Attend
I hereby certify that, to the best of my knowledge, the provided information is true and accurate. I understand that the information I give for this registration will only be used by St. Paul Missionary Baptist Church for the purposes of administering the program.
*
Yes
No
I grant my child permission to attend and participate in the 2024 What a Mess! Vacation Bible School sponsored by St. Paul Missionary Baptist Church, 821 B Street, St. Albans, WV 25177 from July 15th, 2024 to July 19th, 2024. I understand and acknowledge that VBS activities, including church provided transportation, have inherent dangers that no amount of care, caution, instruction or experience can eliminate, and I expressly and voluntarily assume all risk for personal injury sustained by my child while participating in these activities whether or not caused by the negligence of the released parties.
*
Agree
Disagree
We understand that plans may change; however, it is helpful to have an estimate of attendance for planning purposes. Please Select All Dates That Apply. My child will attend Vacation Bible School on the following day(s):
Monday, July 15, 2024
Tuesday, July 16, 2024
Wednesday, July 17, 2024
Thursday, July 18, 2024
Friday, July 19, 2024
Custodial Parent/Legal Guardian Signature
*
Date
*
-
Month
-
Day
Year
Date
Please verify that you are human
*
Click submit below to finish registering your child. You will have the option to register another child after you click submit. Please submit one (1) application per child.
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