K3 – 5th Grade

 

June 14 – 16 ~ 5:30 – 8:00 p.m.

Supper at 5:30, VBS at 6:30

 

June 17 ~ 10:00 a.m. – 1:00 p.m.

FUN DAY! Inflatables, fun games, hot dogs & hamburgers

 

Meet a few of our VBS friends!

Parents, REGISTER your child here!

Child's Name

if child is preschool age, he/she must be potty-trained

Parent(s)/Guardian(s) Name

Your Email

Address

City

State - Zip Code

Home Phone

Cell Phone

Child's Age

Date of Birth

Child's Last Grade Completed (as of May 2017)

Home Church

IN CASE OF EMERGENCY

Primary Contact

Phone Number

Secondary Contact

Phone Number

Allergies or Medical Conditions (if any)

Dietary Restrictions (no milk, peanuts, etc.)

Any additional information you would like to provide

Transportation is available upon request. I would like to take advantage of this service:
YesNo

I give permission for my child's picture to be taken:
YesNo

I give permission for my child's picture to be used for promotional purposes:
YesNo

I give permission for my child's picture to be posted to social media:
YesNo

Parent/Guardian Consent:

I have agreed to submit this application by electronic means. By signing this application electronically, I certify under penalty and false swearing that my answers are correct and complete to the best of my knowledge. I also certify that I understand the questions and statements on this application as well as the penalties for providing falsified information herein. By typing my name below, I am electronically signing my application and do understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature.

consent

I, the undersigned parent or guardian, do hereby grant permission for the above named child to attend Vacation Bible School at First Free Will Baptist Church on June 14 - 16, from 5:30 - 8:00 PM, and on June 17, from 10:00 AM to 1:00 PM. In the event of an emergency where medical treatment is required, I give permission to the church staff to obtain the services of a licensed physical. I understand that the emergency contact person or myself will be notified immediately concerning any such emergency. I do hereby release and discharge the adult leaders, event staff and First Free Will Baptist Church from any and all debts, judgments or suits of any kind that may arise by my child's participation in this event. Payment of any medical expenses will be paid by me or by my insurance company.

Type Full Name