VBS Registration Form
Please fill out this form to complete the Bella Vista Assembly of God VBS waiver.
Participant's Name
First Name
Last Name
Participant's Birthday
Month/Date/Year
Participant's Grade
Grade completed in the 2023-2024 school year
Parent/Guardian Name
First Name
Last Name
Parent/Guardian Email
example@example.com
Parent/Guardian Phone
Please enter a valid phone number.
Emergency Contact Name
First Name
Last Name
Emergency Contact Phone
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please list any food allergies or medical conditions
I authorize the VBS staff to seek emergency medical treatment for my child if necessary.
Yes
No
Bella Vista Assembly of God has my permission to use my child's photograph publicly to promote the church and the children's ministry. I understand the images and/or videos of my child may be used in online publications, presentations, websites, and social media. I also understand that no royalty, fee, or other compensation shall become payable to me by reason of such use.
Yes
No
Signature:
____________________________________________________________
Should be Empty: