Vacation Bible School Ages 4 Years - those entering 7th Grade in the Fall

Child's Name

Parent's Name

Address

This address will receive a confirmation email

Best Phone Contact Number

Emergency Contact Name

Emergency Phone Number

Chiild's Age

Grade Entering in Fall

Pre-K (PreK/K Limited to 10) Kindergarten(PreK/K Limited to 10) 1 2 3 4 5 6 7

Child's Allergies/Medical Needs

Medical Release - As a parent/guardian, I give my permission for the above minor to attend VBS I authorize treatment under the direction of any licensed physician of the above minor in the event of a medical emergency which in the opinion of the attending physician my endanger his or her life, cause disfigurement, physical impairment or undue discomfort if delayed. This authority is granted after reasonable effort has been made to reach me by phone. I will not hold the church, or their staff, administration, or workers, liable for any injury to or loss of possessions by the above minor during any activity either on the church property or away, including regular meetings as well as special events.

Yes NO

Photo Release - I give permission for the above named child(ren) to be photographed during VBS, and for the images to be published, reproduced or distributed by Faith Community Baptist Church in all outlets, including, but not limited to, internet and church publications, without liability or limitation on my or my minor’s part

YES NO

Vacation Bible School Ages 4 Years - those entering 7th Grade in the Fall

Description

Please Fix the Following