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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
[object Object]
2nd child Birth date
*
2nd child T-shirt size
*
3rd child name (if applied)
*
First
Last
[object Object]
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.
Church
About Us
Get Connected
Online Sermons
Events
CampAgape
Harvest Festival
VBS
Give
Contact Us
COVID RELIEF