VBS 2022 REGISTRATION

First and last name required. If registering multiple children, list their information respectively in the SAME ORDER in each field below.

Enter N/A if either name is not applicable

We will TEXT you if you are needed

In the event of a medical emergency, I herewith authorize treatment of the above minor(s) under the direction of any licensed physician. The authority is granted only when a reasonable effort to reach me by phone at the listed numbers has occurred. The undersigned assumes the responsibility of any cost and releases Bella Vista Baptist Church from any liability. This release is signed with the sole purpose of providing medical treatment under emergency circumstances in my absence.

I understand and consent that my child(ren) may appear in videos, photos, slide shows, fliers, brochures, and announcements. These images may be posted online or distributed through print. I consent that they may be used for internal documentation and/or promotional materials/media.