East Side F.W.B Vacation Bible School Registration
Student and Family Information
Student’s Name
*
Parent/Family/Guardian Name
*
Address - Street
Address - Line 2
Address - City/State/ZIP or Additional Info
E-mail Address
example@example.com
Phone Number (Home)
*
Please enter a valid phone number.
Format: (000) 000-0000.
Phone Number (Cell)
Please enter a valid phone number.
Format: (000) 000-0000.
Phone Number (Work)
Please enter a valid phone number.
Format: (000) 000-0000.
Child Date of Birth
*
-
Month
-
Day
Year
Date
Age
*
Last School Grade Completed
*
Friends of your child at this church
Health and Emergency Contacts
Special Needs / Allergies / Medical Information / Other
*
Emergency Contact 1 - Name
*
Emergency Contact 1 - Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact 2 - Name
Emergency Contact 2 - Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Authorized Pickup Persons
*
Permissions and Church Use
Registration Disclaimer & Agreement
By completing and submitting this Bible school registration form, I acknowledge and agree to the following: I am registering my child to participate in the Bible school program voluntarily. I understand that there are inherent risks associated with any activity involving children. I hereby release, indemnify, and hold harmless the church, its staff, volunteers, and the Bible school vendor from any and all liability, claims, demands, or causes of action that may arise from my child’s participation, including any injury, illness, or accident. I confirm that all information provided is accurate and complete. I authorize the Bible school staff to seek emergency medical treatment for my child if necessary. I also grant permission for photographs and/or videos of my child to be taken and used for promotional, educational, or ministry purposes.
Parent/Guardian’s Signature
Signature Date
-
Month
-
Day
Year
Date
Submit
Submit
Should be Empty: