REGISTRATION

VBS Registration

CHILDS INFORMATION

* Indicates required field

Child’s Name ( one form per child ) *

First

Last

Age *

Grade completed *

Date of Birth *

Allergies or Medical concerns if any *

PARENT/GUARDIAN INFORMATION

Parent or Guardian Name *

First

Last

Phone Number *

Alternate Number *

Email Address *

Home Address *

Line 1

Line 2

City

State

Zip Code

Country

EMERGENCY CONTACT (OTHER THAN PARENT) INFORMATION

Emergency Contact Name *

First

Last

Phone Number *

Relationship to child *

AUTHORIZED PICK-UP PEOPLE (OTHER THAN PARENT/GUARDIANS) *

Media Release: I give permission for my child’s photo/video to be taken during VBS and used in church-related materials. *

Yes No

Liability Waiver: I understand that while every effort will be made to provide a safe and fun environment, Bala Chitto Baptist Church is not liable for any injuries or incidents that may occur. I also affirm that the information I’ve provided is accurate to the best of my knowledge. *

Would you like to volunteer? *

Yes, I’d love to help! No, Thank You

Thank you for giving us the opportunity to teach your child(ren) more about God and give them the opportunity to have fun at the same time that they learn!

Signature *

Date *

Submit

VBS Registration

Location

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