Child
Registration

Child's Name *
Child's Name
Parent/Legal Guardian Name *
Parent/Legal Guardian Name
Address *
Address
Home Phone *
Home Phone
Cell Phone *
Cell Phone
Child's Birthdate *
Child's Birthdate
In case of emergency, whom do we call? *
In case of emergency, whom do we call?
Emergency Contact Phone Number *
Emergency Contact Phone Number
I need transportation to and/or from VBS. *
This acts as a digital signature.
Date Signed *
Date Signed
Medical Release Form
Child's Name *
Child's Name
I, the undersigned parent or legal guardian of the below mentioned child, a minor, do hereby authorize adult volunteers of First Baptist Church as agent(s) for the undersigned to consent to any medical or surgical care deemed advisable by any accredited physician or surgeon in an approved emergency clinic or hospital. I further release from any liability First Baptist Church including any of its ministers, leaders or volunteers in the event of an accident enroute, during or returning from the above-mentioned event. This agreement does not apply to claims for intentional misconduct or gross negligence.
Date Signed *
Date Signed
Parent/Legal Guardian *
Parent/Legal Guardian
Address *
Address
Emergency Phone (Home) *
Emergency Phone (Home)
Emergency Phone (Work) *
Emergency Phone (Work)
Does your child have any medical or special needs, including medications currently being used. *
Doctor's Phone Number *
Doctor's Phone Number
Dentist's Phone Number *
Dentist's Phone Number
Date of last tetanus shot *
Date of last tetanus shot