CBC Tallula #2024BC

CBC Tallula #2024BC

Vacation Bible Camp Registration Form
STUDENT INFORMATION
Name

First NameLast Name
Birth Date *

MonthDayYear
Date
Gender
Grade completed by *
Home Church (if any)

Add Additional Children
Name

First NameLast Name
Birth Date *

MonthDayYear
Date
Gender
Grade completed by *
Name

First NameLast Name
Birth Date *

MonthDayYear
Date
Gender
Grade completed by *
Name

First NameLast Name
Birth Date *

MonthDayYear
Date
Gender
Grade completed by *
Name

First NameLast Name
Birth Date *

MonthDayYear
Date
Gender
Grade completed by *
Name

First NameLast Name
Birth Date *

MonthDayYear
Date
Gender
Grade completed by *

Household Information
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number
Please enter a valid phone number.
Secondary Phone Number
Please enter a valid phone number.
EMERGENCY CONTACTS
Please list the first and last names and phone numbers off ALL adults who are allowed to pick up this child. The child will only be released to these people.
Primary Guardian*

First NameLast Name
Relationship to child*
Phone Number*
Alternate Guardian #1

First NameLast Name
Relationship to child
Phone Number
Alternate Guardian #2

First NameLast Name
Relationship to child
Phone Number

Medical Information
Please list all allergies -- or type "none" if there are none*
Do any of your child carry an epi-pen? (please note: if yes, it is the responsibilty of the child's guardian to ensure the child has the epi-pen at every drop off and pick up)*

YesNo
Please list all medical concerns -- or type "none" if there are none*
Additional Information
Church event photos/videos are taken for promotional purposes related to Calvary Baptist Church and Vacation Bible Camp. These pictures may appear in various media outlets such as our facebook page and webpage. Do you allow your child to be included in these photos/videos?*

YesNo
All children listed above need to be picked up and dropped off for Vacation Bible Camp from July 31 - August 3rd. They will be ready by 6:15pm for pick-up and drop off will be up to 15 minutes after 8:30pm when camp ends. August 4th is family day, and will be held during regular church hours from 10am to 12pm.*

YesNo
I give my permission for all children listed above to ride the van or other vehicles used for church functions. I understand that my children will be under adult supervision. I further understand that in signing this form, I release and hold harmless Calvary Baptist Church and all other church-related functions. By signing this form, I release and hold harmless its trustees, officers, employees, interns, and any volunteers from any liability, past or future, fully and completely. I authorize the staff or designated medical professionals and/or volunteers to administer emergency medical assistance if I cannot be reached.*

YesNo

By submitting this form, I ackowledge I have read and understand the above information.
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CBC Tallula #2024BC

Household Information

Medical Information

Additional Information