Vacation Bible School - Registration
New Hope Baptist Church - 830 Choate Rd, Salisbury, NC 28146 - 704.633.2107 - July 29-August 2, 2018
STUDENT'S INFORMATION
Student's First Name *
Your answer
Student's Last Name *
Your answer
Bus # or Drive-In *
Date of Birth
MM
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DD
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YYYY
Gender *
Address *
Your answer
City *
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State *
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Zip *
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Home Phone
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Church that Student Regularly Attends
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PARENT/GUARDIAN INFORMATION
Parent/Guardian's Full Name *
Your answer
Relationship to Student
Your answer
Home Phone
Your answer
Cell Phone
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Work Phone
Your answer
SECONDARY EMERGENCY CONTACT INFORMATION
Parent/Guardian's Full Name
Your answer
Relationship to Student
Your answer
Home Phone
Your answer
Cell Phone
Your answer
Work Phone
Your answer
MEDICAL INFORMATION
Student's Allergies or Medical Conditions
Your answer
Person other than those listed above authorized to pick up your child from VBS
Your answer
Permission / Liability Waiver
I, as parent/guardian of the above listed child, hereby grant permission necessary to allow child to participate in activities (including Vacation Bible School) conducted by New Hope Baptist Church (NHBC) and to be transported to and from those activities by the staff, volunteers, and vehicles of NHBC. I further agree to release and hold harmless NHBC from any liability or any claim judgment, loss, cost, and expenses arising out of or connected with NHBC, including any claim arising out of or connected with any illness or injury (minimal, serious, catastrophic, and/or death) that the child may incur or sustain during activities associated with NHBC or while traveling to, within, and from the activities. I authorize NHBC to obtain medical treatment for the child if deemed necessary by the staff or designated volunteer of NHBC and hereby release and hold harmless NHBC in the exercises of this authority. I understand that as a participant and/or spectator at NHBC activities that the child may be included in video recordings or photographs taken during the activities. Therefore, I grant permission to NHBC to use such materials as deemed appropriate by the staff.
Parent/Guardian Name
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