2017 VBS at J-Bar-C Cowboy Church
July 16th thru July 19th


Dinner will be served at 6:00

VBS 2017 Parental Authorization & Release Form

Child's First Name *
Your answer
Child's Last Name *
Your answer
Age (must be be fully potty trained) *
Grade completed in the 2016-2017 School Year *
Address *
Your answer
City *
Your answer
State *
Zip Code *
Your answer
T - Shirt Size *
$10 - - Shirt must be paid for by Sunday, July 9h
Food and/or Medication Allergies or Medical issue *
The ONLY Adults allowed to Pick UP your Child. *
Please give the names of the People (up to 3) that you authorize to VBS to PICK UP your Child from VBS. They will be asked to show a VALID Drivers License at the time of pick. NO EXCEPTIONS!!!
Your answer
I understand by hitting submit - - That I am: The undersigned person ("Guardian"). being the parent, legal guardian, or other person authorized by law to enther into the AUTHORIZATION and RELEASE on the behalf of ________________ ("Participant"), a minor aged 17 or younger, enters into this agreement on the behalf of the Participant. Guardian and Participant desire that the Participant participate in one or more events and activities sponsored, organized, sanctioned, and/or held at the facilities provided by the J BAR C Cowboy Church ("the Cowboy Church). *
Type in your child's name
Your answer
Parent First and Last Name *
Your answer
Parent Phone Number *
Please your Cell
Your answer
Parent Email Address *
If you do not have an email, just type none.
Your answer
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