VBS Registration Form

VBS Registration Form

MORNING STAR MISSIONARY BAPTIST CHURCH- JUNE 24-JUNE 26 5:30-8:30pm
Institution Name
Participant Information
Name

First NameLast Name
Age
Birth Date

MonthDayYear
Date
Gender
Highest Grade Completed
Have you previously attended VBS?
If yes, what year?
Home Church (if any)
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.
Siblings Enrolled in VBS
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
Does 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
VBS photos/videos are taken for promotional purposes related to Morning Star Missionary Baptist Church and Vacation Bible School. These pictures appear in various media outlets such as news outlets and our Facebook page and webpage. Do you allow your child to be included in these photos/videos?
Medical Release, Emergency Authorization, and Liability Waiver- I, the parent/legal guardian of the child listed on this registration form, give permission for my child to participate in Vacation Bible School at Morning Star Missionary Baptist Church on June 24–26 from 5:30 p.m. to 8:30 p.m. I understand that participation may involve certain risks of injury. I voluntarily assume these risks and release and hold harmless Morning Star Missionary Baptist Church, its staff, volunteers, and representatives from any claims or liability arising from my child's participation, except in cases of gross negligence or willful misconduct. In the event of an accident, illness, or medical emergency, and I cannot be reached, I authorize church representatives to obtain emergency medical treatment for my child. I understand that reasonable efforts will be made to contact me and that I am responsible for any related medical expenses. I certify that any medical conditions, allergies, medications, or special needs have been disclosed on this registration form. I acknowledge that I have read and agree to this Medical Release, Emergency Authorization, and Liability Waiver.
By submitting this form, I acknowledge I have read and understand the above information.
Signature
Should be Empty:

VBS Registration Form

Medical Information

Additional Information