VBS Registration Form

VBS Registration Form

Greenwood Baptist Church 3400 Gray HWY Gray GA 31032
1st Child's Name

First NameLast Name
Date of Birth

MonthDayYear
Gender
Last Grade Completed
Allergies
2nd Child's Name

First NameLast Name
Date of Birth

MonthDayYear
Gender
Last Grade Completed
Allergies
3rd Child's Name

First NameLast Name
Date of Birth

MonthDayYear
Gender
Last Grade Completed
Allergies
4th Child's Name

First NameLast Name
Date of Birth

MonthDayYear
Gender
Last Grade Completed
Allergies
Parent's/Caregiver Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent's/Caregiver Cell Phone
Format: (000) 000-0000.
Parent's/Caregiver Home Phone
Format: (000) 000-0000.
Please list the names of those who will be allowed to pick up child (other than parent)
MEDICAL, PUBLICITY AND CHILD RELEASE AUTHORIZATION

I, the parent and/or legal guardian of the above named minor(s) do hereby appoint Greenwood Baptist Church to act on my behalf in authorizing emergency medical, dental, surgical care and/or hospitalization for this child/children in the event I cannot be reached. I agree to be financially responsible for all treatment. I give permission for my child to be picked up by the persons listed above. I give permission for my child's picture to be used in all Greenwood Baptist Church publications.
Parent Signature _____________________________ Date
Should be Empty: