TIMELESS Vacation Bible School 2025

TIMELESS Vacation Bible School 2025

July 7-11, 2025 • 6pm - 8:30pm
Please fill out the registration form completely. Each child attending must have a separate registration form filled out.

If you have any questions: contact our VBS Director, Amanda Lewis 559.301.1134, or lewis.amandak@gmail.com.
Child/Teen Info
Name*

FirstLast
MaleFemale
Age*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name*

FirstLast
Relationship to Child*
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Emergency Contact Information

This should be different from the parent info above
Name*

First NameLast Name
Relationship to Child*
Phone Number*
Please enter a valid phone number.
Name

First NameLast Name
Relationship to Child
Phone Number
Please enter a valid phone number.
Please list all additional persons authorized to pick up your child, in the event it is not a parent a valid photo ID will be required at sign-out.*
Please list all additional persons your child is authorized to contact (should the need arise) and their relationship to the child. Please also include a contact number.*
Health Information
Please list any and all allergies, chronic illnesses or medical conditions we should be aware of. (There will be snacks, so please be sure to include any food allergies).*
I would like my child to wear a wristband indicating food allergies or special need.

yesno
Medical Release and Authorization

As parent/guardian of the named child, I hereby authorize the diagnosis and treatment, by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor's life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort. Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named child. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me. Permission is also granted to the First Missionary Baptist Church and its affiliates, including leaders and teachers, to provide the needed emergency treatment prior to the child's admission to the medical facility.

Release authorized on the dates and/or duration of the registered Vacation Bible School 2025. This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor chiled, in my absence.
Informed Consent and Acknowledgement

I hereby give my approval for my child's participation in any and all activities prepared by First Missionary Baptist Church during the selected Vacation Bible School 2025 period. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve, and hold harmless First Missionary Baptist Church of Fresno, and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising during the Vacation Bible School 2025 sessions. In case of injury to said child, I hereby waive all claims against First Missionary Baptist Church including all leaders, and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event.

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.

***Note, photos of Vacation Bible School may be posted on the social media and website of First Missionary Baptist Church, its affiliates, and other participants of Vacation Bible School 2025. ***
Signature*

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TIMELESS Vacation Bible School 2025

Child/Teen Info

Parent/Guardian Information

Emergency Contact Information

Health Information