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Pastor Position
VBS 2024 REGISTRATION
Ages: 4 years old - completed 6th Grade
CHILD(REN'S) INFORMATION
Child Name(s)
First and last name required. If registering multiple children, list their information respectively in the SAME ORDER in each field below.
Date(s) of Birth
Age(s)
Sex (M/F)
School(s)
Grade(s)
PARENT/GUARDIAN INFORMATION
Mother/Guardian Name
Father/Guardian Name
Enter N/A if either name is not applicable
Parent/Guardian Address
Parent/Guardian Cell #
We will TEXT you if you are needed
Home Church (if applicable)
MEDICAL INFORMATION
List any physical/mental disabilities that will require special attention (if registering multiple children, list child's name first followed by medical information)
List any allergies (if registering multiple children, list child's name first followed by medical information)
Emergency Contact Name (NOT a parent/guardian listed above)
Emergency Contact Phone #
Emergency Contact's Relationship to Child(ren)
RELEASES
MEDICAL RELEASE
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.
PHOTO/MEDIA RELEASE
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.
Parent/Guardian Signature
Email Address
Register Child(ren)
