CONCORD BAPTIST CHURCH
VBS July 13-16, 2026
Child’s name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Child’s Birthdate
-
Month
-
Day
Year
Date
Grade finished
Please Select
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
Parent/Guardian information
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Emergency contact
First Name
Last Name
Relationship
Please Select
Mother
Father
Grandparent
Guardian
Aunt
Uncle
Sibling
Emergency contact number
Please enter a valid phone number.
Format: (000) 000-0000.
Does your child have any allergies, chronic illness or medical conditions? If yes, please describe.
Has your child been prescribed an inhaler or EpiPen? If yes, it is the parent/guardian’s responsibility to drop off with nurse at drop off.
I hereby give my child permission to attend any and all activities provided by Concord Baptist Church during VBS. I assume all risks and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Concord Baptist and all of its representatives from any and all liability for injuries to said child. In case of injury to said child, I hereby waive all claims against Concord Baptist, including all leaders and participants.
As parent and or guardian of the named child, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency which in the opinion of the medical professional requires immediate attention to prevent further endangerment of the minor’s life, physical impairment, or other undue pain, suffering or discomfort, if delayed. Release authorized on the dates and/or duration of the registered season.This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence. Release authorized on the dates and/or duration of the registered season. This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.
Do you allow your child to included in photos/videos? Photos and videos will be used in a slideshow and may appear of the church Facebook page.
Please Select
Yes
No
Authorized person to pick up at dismissal
First Name
Last Name
First Name
Last Name
Relationship to child
Please Select
Mother
Father
Grandparent
Guardian
Aunt
Uncle
Sibling
Relationship to child
Please Select
Mother
Father
Grandparent
Guardian
Aunt
Uncle
Sibling
Submit
Should be Empty: