Corinth Baptist Church
VBS 2026 Student Participant Form
Child's Name
*
First Name
Last Name
Birth Date
*
Please select a month
January
February
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Month
Please select a day
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Day
Please select a year
2026
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Year
Last Grade Completed
*
Please Select
Pre-K
Kindergarten
First
Second
Third
Fourth
Fifth
Phone Number
*
Format: (000) 000-0000.
Please provide any medical or dietary restrictions
Primary Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Transportation
Next
Family Information
Parent/Guardian's Name
*
First Name
Last Name
Contact Phone Number
*
Format: (000) 000-0000.
E-mail Address
*
example@example.com
Back
Next
Emergency Contact Information
In the event Parent/Guardian cannot be reached
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Format: (000) 000-0000.
Relationship to Student
*
Back
Next
Transportation
Select One...
*
Please Select
Parent/Guardian
Church Van
Pickup List
List if someone besides parent/guardian can pickup child
Name
First Name
Last Name
LIABILITY RELEASE:
In consideration of Corinth Baptist Church. allowing the above child(ren) to participate in Vacation Bible School activities, I, the undersigned, do hereby release, forever discharge, and agree to hold harmless Corinth Baptist Church, its directors, employees, volunteers, and agents (collectively herein the “Church”) from any and all liability, claims or demands for accidental personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the above child(ren) while involved in Vacation Bible School. Furthermore, on behalf of my minor child(ren), I hereby assume all risk of accidental personal injury, sickness, death, damage, and expense as a result of participation in activities involved therein.
PHOTO/VIDEO PERMISSION:
I DO give my consent to Cornith Baptist Church to use photo or video images taken of my child(ren) in church brochures, advertisements for the church, on the website, in social media, and in other church publications as they see fit. I agree to hold harmless Cornith Baptist Church from any liability which may result from the use of said picture(s). This form will apply throughout my child(ren)’s tenure at Corinth's Baptist Church's Vacation Bible School. ***None of the photos will be for personal use.
**I hereby give permission for my child(ren) to participate in Vacation Bible School at Corinth Baptist Church on July 12-15, 2026. (Type Parent's/Guardian's Name)
First Name
Last Name
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