VBS 2010 Registration

Child's First Name: Last Name:

Child likes to be called: Age: T-Shirt size:

Guardian's First Name: Last Name:

Street Address:

City: State: Zip:

Telephone: Email:

Do you currently attend a church regularly? If so, which one?

If so, where is your church located? City: State:

Do you need bus pick-up?

If bus pick-up is needed, indicate the address where the child should be picked up if different from above:

Is there anything we should know about your child? (Health concerns, food allergies...etc.)

In case of injury, what doctor should we contact?

Doctor’s Name: Telephone:

Names of others we may contact in case of emergency:

Emergency Contact 1: Telephone:

Emergency Contact 2: Telephone:

By choosing the "I agree" choice below, I allow my child to participate fully in games, crafts, snacks, and Bible activities during the week of July 19-23. I understand that these games and activities may involve running, jumping, throwing, catching, and other active exercises during which injury is always possible. I hold First Baptist Church and any of its members and staff free from any and all liability of injury that may result from participation in such games and activities.