REGISTER ME FOR THE VBS!
Childs Name
Birthdate
/
Month
/
Day
Year
Date
Gender : Male?
Please Select
Yes
No
Gender : Female?
Please Select
Yes
No
Grade completed
Address
Address
Street Address Line 2
City
State
Zip
Parent / Guardian
Phone
Format: (000) 000-0000.
Email
example@example.com
Emergency Contact
Relationship to child
Phone
Format: (000) 000-0000.
Name of Home Church
Food Allergy?
Yes
No
If Yes, please list the allergies.
Medical Concerns?
Yes
No
If Yes, please list the medical concerns
WHO CAN PICK UP YOUR CHILD?
Who Can Pick Up Your Child
Relationship To Child
Contact Number
Please enter a valid phone number.
Format: (000) 000-0000.
Who Can Pick Up Your Child
Relationship To Child
Contact Number
Please enter a valid phone number.
Format: (000) 000-0000.
I hereby grant permission for Living Waters Baptist Church to record sounds, images, or video of my child, while attending this VBS program. I also give permission for Living Waters Baptist Church at its sole discretion, to use these sounds, images, or videos in publications (including print, websites, and social media platforms) owned by Living Waters Baptist Church in relation to this VBS program.
Name Of Child
I hereby consent to allow my child, to participate in all activities of Living Waters Baptist Church Vacation Bible School. I hereby waive, release, and hold harmless Living Waters Baptist Church, the VBS director, and all adult and youth supervising sponsors from all liability, damages, injuries, claims, demands and causes of action I and/or any family member may have arising out of VBS.
Name Of Child
Should my child require emergency medical treatment as a result of accident or illness arising during VBS I consent to such treatment I acknowledge that Living Waters Baptist Church does not provide health and accident insurance and I agree to be financially responsible for any medical treatment
Name Of Child
PARENT SIGNATURE
DATE
/
Month
/
Day
Year
Date
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