Greenpond 2025 VBS Registration Adventure Survival Camp

Greenpond Baptist Church VBS 2025 Registration & Permission Form

(must be signed at bottom)
Greenpond Baptist phone number to call if needed: 434-251-8043
Child's Name*

First NameLast Name
Childs Birthday*

MonthDayYear
Date
Childs Age*
Grade level during school year 2024-25:*
Gender*

MaleFemale
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Parent/Guardian Name*

First NameLast Name
Home Telephone Number
Cell Number*
E-mail
example@example.com
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
Alt. Phone Number
Does the child have any allergies, chronic illness, or medical conditions? If yes, please describe.
Please put NO if not applicable
Is the child prescribed an inhaler? If yes, please explain any instructions.
Please put NO if not applicable.
I give permission for the following adults to pick up my child/children from Greenpond VBS: (Please note: A photo-id will be required for pickup)

First NameLast Name
Informed Consent and Acknowledgement

I hereby give my (our) permission for our child(ren) above to participate in VBS at Greenpond Baptist Church, in all activities, including Archery, Rock Climbing and Obstacle Course. I acknowledge that Greenpond Baptist Church is not responsible for any accidental injuries.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
sign date*

MonthDayYear
Date
Signature*

Clear
Should be Empty:

Greenpond Baptist Church VBS 2025 Registration & Permission Form

Greenpond Baptist phone number to call if needed: 434-251-8043