VBS Registration 2025

Vacation Bible School Registration
Name of the Child*

First NameLast Name
Age*
Gender*

MaleFemale
Rising Grade Level*
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mom’s Name*
Mom’s Phone Number*
Please enter a valid phone number.
Dad’s Name*
Dad’s Phone Number*
Please enter a valid phone number.
Does your family have a church home? (Yes/No)*
If yes, where do you attend?*
Does your child have any allergies?*

YesNo
What are the allergies of your child?*
Is he/she carrying an Epi-pen at all times?*

YesNo
Does your child have any medical condition that we should be aware of?*

YesNo
What is this medical condition? Please explain below:*
Pick Up Authorization

Authorized person/s to pickup your child after Vacation Bible School
Full Name 1*

First NameLast Name
Relationship*
Full Name 2*

First NameLast Name
Relationship*
Emergency Contact Information
Emergency Contact 1*

First NameLast Name
Relationship*
Phone Number*
Please enter a valid phone number.
Emergency Contact 2*

First NameLast Name
Relationship*
Phone Number*
Please enter a valid phone number.
Consent
I, as the parent or legal guardian of the registered participant who is currently under the age of 18, grant permission for him/her to attend Atlantic Baptist Church 2025 Vacation Bible School and also do hereby release Atlantic Baptist Church from any and all liability or responsibility due to any injury that he/she may incur as the result of, or arising in any way from participation in activities at or under the direction of Atlantic Baptist Church. I am fully aware and consent to accept these risks and voluntarily agree to allow his/her participation in activities. If I cannot be consulted in an emergency, I hereby give permission to the physician selected by a representative of Atlantic Baptist Church to hospitalize or secure treatment for the person named above. I understand that Atlantic Baptist Church only carries secondary insurance and that I will take primary responsibility for any fees or charges at any clinic, facility, or hospital arising from treatment of injury or illness. I furthermore understand Atlantic Baptist Church often takes photographs or videos of participants during its activities or events. I grant permission without compensation that these photographs or videos may be used in publications, presentations, websites or promotion of Atlantic Baptist Church.

I hereby certify that I have read this waiver document; and I understand its content.
Parent/Guardian Signature*

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Date Signed*

MonthDayYear
Date
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Vacation Bible School Registration

Pick Up Authorization

Emergency Contact Information

Consent