VBS 2024

Wednesdays

6:30PM-9:30PM
Child #1 Information
Name*

First NameLast Name
MaleFemale
Age*
Please list any allergies, medical conditions, or significant info regarding child*
YesNo

Child #2 Information
Name

First NameLast Name
MaleFemale
Age
Please list any allergies, medical conditions, or significant info regarding child
YesNo

Child #3 Information
Name

First NameLast Name
MaleFemale
Age
Please list any allergies, medical conditions, or significant info regarding child

Parent/Guardian Information
Name*

First NameLast Name
Contact Number*
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Emergency Contact (other than above)*

First NameLast Name
Emergency Contact Phone 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 White Graves Baptist Church (WGBC) during the selected Bible Club period. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless WGBC and all its respective officers, agents, and representatives from any and all liability for injuries to said child(ren) arising during the Bible Club sessions. In case of injury to said child(ren), I hereby waive all claims against WGBC 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

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Wednesdays