HBT VBS 2026

Child #1 Information

Name

First NameLast Name

Gender

Age

Please list any allergies, medical conditions, or significant info regarding child

Child #2 Information

Name

First NameLast Name

Gender

Age

Please list any allergies, medical conditions, or significant info regarding child

Child #3 Information

Name

First NameLast Name

Gender

Age

Please list any allergies, medical conditions, or significant info regarding child

Parent/Guardian Information

Name

First NameLast Name

Contact Number

Area CodePhone Number

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Emergency Contact (other than above)

First NameLast Name

Emergency Contact Phone Number

Area CodePhone Number

Individual(s) authorized to pick up/drop off child(ren) with proof of ID.

*Names already listed on form as guardian or emergency contact will not require ID

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

I AGREE

Confirmation BY SIGNING BELOW, I AM ACKNOWLEDGING THAT MY ELECTRONIC SIGNATURE 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.

Signature