Exeter Bible Fellowship
VBS 2019 Registration Form
August 19-21, 2019 9:00 a.m. to 12:00 daily
CHILD'S NAME: _____________________________
Last Name: First
AGE:
BIRTHDATE: ______________
/
Month
/
Day
Year
Date
HEALTH CARD
FOOD/MEDICAL ALLERGIES
OTHER INFORMATION WE SHOULD KNOW
PARENT/GUARDIAN NAME:
PHONE #:
PHONE # 2:
EMAIL ADDRESS:
example@example.com
ADDRESS:
ADDRESS:
HOME CHURCH (if applicable)
EMERGENCY CONTACT: __________________________________
Name and phone
WAIVER, MEDICAL PERMISSION and PRIVACY DISCLOSURE STATEMENT
I understand that, while the teachers, helpers and leaders of Exeter Bible Fellowship VBS will take precautions to ensure the safety of all children while they are at Vacation Bible School, I will not hold them liable for any injury or cost incurred by injury during the activities of VBS; I acknowledge that it is my responsibility to advise Exeter Bible Fellowship VBS of any medical or health concerns of my child that may affect his/her participation in the activities of VBS; I authorize the ministry staff of Exeter Bible Fellowship VBS to sign consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures for the participant named above.
I understand that the contact information collected on this form may be used by Exeter Bible Fellowship to invite me/us to future events and activities of the congregation;
Photos and videos taken of VBS activities and participants may be displayed in the church, on the internet, and/or used for promotional purposes outside of the church. No personal names or other private information will be published without consent.
I HAVE READ THE ABOVE AND AGREE TO THE CONDITIONS.
Signed on the _______________day of__________________ , 2019.
Signature of Parent/Guardian: _________
Please Print Name:__________________________________________________________
Review and Submit
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