Illumination Station VBS 2026 Child Registration Form

VACATION BIBLE SCHOOL 2026

JULY 20 - 24, 2026

REGISTRATION FORM
Child's Name

First NameLast Name
Parents or Guardian Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Child’s Age
We are accepting kids ages 5-10.
MEDICAL INFORMATION
Allergies:
Takes Medications:
List below medical or other information we need to know.

EMERGENCY CONTACT INFORMATION

Other then listed in previous page.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relation To Child
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relation To Child
DISMISSAL INFORMATION
Who may pick up your child at the end of each VBS day?
If a person who is not listed to pick up a child does so, the child will not be handed over to that person without the parents or guardians’ authorization.
ACKNOWLEDMENT
I parent or gaurdian's name* , give my child child's name* permission to attend Vacation Bible School 2026 on Monday, July 20 to Friday, July 24, 2026 from 6:30 P.M. to 8:30 P.M. and also to participate in the celebration on Sunday, July 26, 2026 at 11:00 A.M.

DISCLAIMER
I acknowledge that the programs of Primera Iglesia Bautista Hispana of Cleveland are administered by volunteers, rather than by paid, trained professionals. In consideration for accepting the registration of the named individual Child's name* and permitting the voluntary participation of said individuals, in its programs, I (for myself as well as for my child, his heirs and assigns) hereby release, discharge, and hold harmless Primera Iglesia Bautista Hispana of Cleveland, and their employees, volunteers, and other representatives or affiliates (including without limitation the participating churches, organizations participating through such churches, sponsors, games or event workers, officials, facilities, and volunteers) from and against any and claims arising out of or relating to illness, physical injury, death or other damagers that may result to said individual while participating in a Primera Iglesia Bautista Hispana of Cleveland, sponsored event, including any physical injury by negligence of any official, referee or coach while performing his/her duties during any practices or games, or other activities.

I attest that my child is physically capable to participate in this program. However, should officials, representatives or volunteers determine in their sole discretion that completion or participation in any games or events would be injurious to my child”s health, or should my child become ill or sick, I consent to his or her removal and treatment by any physician or medical care provider at the direction of the event or game officials, sponsors, representatives and/or volunteers.

I give my permission for free use of my child's name and picture in broadcasts, telecasts or written accounts of any game, practice or participation in any Primera Iglesia Bautista Hispana of Cleveland event.
Parent or Guardian Name
Print
Parent or Guardian Signature
Date

MonthDayYear
Date
Should be Empty:

VACATION BIBLE SCHOOL 2026

REGISTRATION FORM

MEDICAL INFORMATION

EMERGENCY CONTACT INFORMATION

DISMISSAL INFORMATION

ACKNOWLEDMENT

DISCLAIMER