Second Baptist Church of Beech Island
VBS Registration
Student Name
First Name
Last Name
Age
Date of Birth
-
Month
-
Day
Year
Date
Gender
Male
Female
Last Grade Completed
Home Phone
Please enter a valid phone number.
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian Information
Name 1
First Name
Last Name
Relationship
Phone Number
Please enter a valid phone number.
Name 2
First Name
Last Name
Relationship
Phone Number
Please enter a valid phone number.
Home Church Name
Authorized person who can pickup the child on dismissal (if different from Parent/Guardian)
First Name
Last Name
Consent - Waiver - Release
I consent to my childs participation in the events at Second Baptist Church of Beech Island.
By allowing the child to participate, the parent or guardian releases Second Baptist Church of Beech Island, its directors, employees, volunteers, and agents from liability for accidental personal injury, sickness, death, property damage, and expenses incurred during VBS. The parent or guardian assumes all risks of injury, sickness, death, damage, and expense for the child's participation.
I confirm Second Baptist Church of Beech Island has my permission to use my child’s photograph publicly in VBS materials. I understand the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use.
Parent/Guardian Signature
Date Signed
-
Month
-
Day
Year
Date
Submit
Submit
Should be Empty: