VBS 2019

Parent/Guardian Name

This address will receive a confirmation email

Phone

Address

Emergency Information

Who will regularly pick up/droff off your child? _____________________

Is there anyone NOT permitted to pick up your child(ren)? Who? _____________

Medical, Media, and Liability Release

In the event of an emergency in which my child is in need of immediate medical attention, hospitalization or surgery, and after reasonable efforts have been made to contact me (parents or guardian) and we can not be located for the purpose of consenting thereto, consent for the emergency attention may be given to any person standing to loco parentis to my child. I understand my own medical insurance will be the primary coverage. I hereby release First Baptist Church, its staff and volunteers, of the liability for injury or damage and assume all risks stemming from my child's participation in VBS. I understand that during VBS my child may be videotaped or photographed. By signing this form I am giving permission for my child to appear in photos or videotape in First Baptist Church services or promotional materials. I give my child's VBS leader permission to contact my child through written communication. This release is completed of my own free will. Granting my permission:

Child # 1 Information

Child Name

Date of Birth

Gender

Male Female

List Allergies

Grade Just Completed

Child # 2 Information

Child Name

Date of Birth

Gender Male Female

List Allergies

Grade Just Completed

Child # 3 Information

Child Name

Date of Birth

List Allergies

Grade Just Completed

Child # 4 Information

Child Name

Date of Birth

List Allergies

Grade Just Completed

Unnamed Label

VBS 2019

Description

Please Fix the Following