Clone of CBC Tallula #2024BC

CBC Tallula #2026BC

Vacation Bible Camp Registration Form
STUDENT INFORMATION
Name

First NameLast Name
Birth Date

MonthDayYear
Gender
Grade completed by
Home Church (if any)
- Name
  
  First NameLast Name
- Birth Date
  
  MonthDayYear
- Gender
- Grade completed by
- Name
  
  First NameLast Name
- Birth Date
  
  MonthDayYear
- Gender
- Grade completed by
- Name
  
  First NameLast Name
- Birth Date
  
  MonthDayYear
- Gender
- Grade completed by
- Name
  
  First NameLast Name
- Birth Date
  
  MonthDayYear
- Gender
- Grade completed by
- Name
  
  First NameLast Name
- Birth Date
  
  MonthDayYear
- Gender
- Grade completed by
- Have More Kids You Want to Sign Up?
  
  Let us know at shadowoftheharvest@gmail.com - give us the name / age / gender and grade for each kid and we will make sure that they are accounted for! Thanks!

Household Information
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Secondary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
EMERGENCY CONTACTS
Please list the first and last names and phone numbers off ALL adults who are allowed to pick up this child. The child will only be released to these people.
Primary Guardian

First NameLast Name
Relationship to child
Phone Number
Format: (000) 000-0000.
Alternate Guardian #1

First NameLast Name
Relationship to child
Phone Number
Format: (000) 000-0000.
Alternate Guardian #2

First NameLast Name
Relationship to child
Phone Number
Format: (000) 000-0000.

Medical Information
Please list all allergies -- or type "none" if there are none
Do any of your child carry an epi-pen? (please note: if yes, it is the responsibilty of the child's guardian to ensure the child has the epi-pen at every drop off and pick up)
Please list all medical concerns -- or type "none" if there are none
Additional Information
Church event photos/videos are taken for promotional purposes related to Calvary Baptist Church and Vacation Bible Camp. These pictures may appear in various media outlets such as our facebook page and webpage. Do you allow your child to be included in these photos/videos?
All children listed above need to be picked up and dropped off for Vacation Bible Camp from June 8th - 13th. They will be ready by 4pm for pick-up and drop off will be up to 15 minutes after 7:30pm when camp ends. June 14th is family day, and will be held during regular church hours from 10am to 12pm.
I give my permission for all children listed above to ride the van or other vehicles used for church functions. I understand that my children will be under adult supervision. I further understand that in signing this form, I release and hold harmless Calvary Baptist Church and all other church-related functions. By signing this form, I release and hold harmless its trustees, officers, employees, interns, and any volunteers from any liability, past or future, fully and completely. I authorize the staff or designated medical professionals and/or volunteers to administer emergency medical assistance if I cannot be reached.

By submitting this form, I ackowledge I have read and understand the above information.
Signature
Should be Empty:

CBC Tallula #2026BC

Have More Kids You Want to Sign Up?

Household Information

Medical Information

Additional Information