VBSRegister

VBS 2018 REGISTRATION & WAIVER RELEASE FORM

Child's information

* Indicates required field

Child's name *

First

Last

Birth Date *

T-shirt size *

2nd child name (if applied) *

First

Last

2nd child Birth date *

2nd child T-shirt size *

3rd child name (if applied) *

First

Last

3rd child birth date *

3rd child t-shirt size *

4th Child Name (If Applied) *

First

Last

4th Child Birth Date *

4th Child T-shirt size *

Parent/Guardian information

Parent/Guardian Name *

First

Last

Adress *

Email *

Phone Number *

Medical or other information we need to know

Medical Information (Please include any food allergies) *

Activity Restrictions (If any) *

Emergency Contacts (Other than listed above)

Name *

First

Last

Phone Number *

As the parent or legal guardian of my child(ren), I hereby consent for my child(ren) to attend and participate in all activities provided by Agape Baptist Church in their VBS program. I hereby consent to any treatment deemed advisable in an emergency by a physician. I also release, indemnify and hold harmless from any liability, Agape Baptist Church, their staffs of any damage be it real or personal.
I also give consent to take photos of my child(ren) during VBS and to be used in VBS videos and social media platforms.

Your Initial *

Please check the box *

Agree

Submit

Donation for VBS 2018.

VBS 2018 REGISTRATION & WAIVER RELEASE FORM

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