Kentuck Baptist Church
Vacation Bible School Registration
Child’s Name (First and Last) *
Child’s grade level completed *
Child’s age as of Sept. 30, 2021 *
Shirt Size(please specify youth or adult) *
Contact Information:
Mother's Name:
Phone Number *
Email Address:
Father's Name:
Phone Number:
Email Address:
Child's Address:
Church Currently Attending:
Emergency Contact Person: *
Emergency Contact Person-Phone Number: *
Emergency Contact Person-Relationship to Child: *
List others whom may pick up your child:
Any special needs that your child has that we should be aware of so that we can best work with them:
Please list facts concerning the child’s medical history, including allergies and medications being taken, and any physical impairment to which a physician should be alerted.
Code of Conduct for Vacation Bible School
I agree to:
1.If your child exhibits unacceptable behavior while at Vacation Bible School, you may be called and asked to pick them up. Your child may be asked not to return for the remainder of VBS.
2.You must have reliable transportation for your child and your child must be picked from the classroom no later than 8:30 p.m. You also must “check -out” your child--please do not just leave with your child until you have let an adult volunteer know that you are leaving.
3.Vacation Bible School will be full of activities, games, and a lot of fun! For that reason other belongings such as video games, toys, cell phones, etc., should be left at home. Your child will have access to a phone to call if he/she need to. Kentuck Baptist Church is not responsible for items that are lost or stolen.
I agree to the code of conduct *
I grant permission:

I give my permission for my child(ren) to participate in Kentuck Baptist Church’s Vacation Bible School taking place June 6-10. I understand the known risks involved in the program for my child(ren) in consideration of Kentuck Baptist Church allowing us to participate in the program .I hereby fully release and forever discharge the parties named above, along with heirs, officers, agents, employees, and volunteers.
In the event of illness or accident, having parental responsibility for the above named child(ren), I give permission for the first aid to be administered where considered necessary by a person trained in first aid, if available, or medical treatment to be administered by a suitably qualified medical practitioner.
If I cannot be contacted and my child(ren) should require emergency hospital treatment, I authorize an adult leader to sign on my behalf any written form of consent required by the hospital. However, I understand that every effort will be made to contact me as soon as possible.
I understand that by my child(ren)’s participation in this church youth activity his/her picture could be taken and used in press releases, brochures, video, CD/DVDs, websites, etc. for publicity use only.
I grant permission *
If you choose to visit, participate, or volunteer in the VBS activities, you may be exposing yourself to and/or increasing your risk of contracting or spreading communicable diseases, including COVID-19. In order to participate each night, you affirm that:
1)You choose to accept the risk of contracting any communicable diseases.
2)You agree to follow all sanitization and social distancing guidelines. Should you break said guidelines you may be asked to vacate the Premises.
3)You are not currently, or at the time of VBS, experiencing any symptoms of illness including, but not limited to, cough, fever, chills, fatigue, muscle aches, diarrhea, headache, sore throat, congestion, runny nose, nausea, vomiting, or shortness of breath.
4)If you have or are exhibiting any of the symptoms above, you will refrain from entering KBC.
5)If you exhibit symptoms while at KBC, you will vacate immediately and self-isolate in accordance with the current CDC and local guidelines.
Parent Signature: (By entering you name in this field you are digitally signing this agreement) *
Date: *
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