Gadgets and Gizmos
The GADGETS & GIZMOS VBS is geared to capture a kids’ imaginations about their
Creator so they can discover how they are . . .

• MADE by God
• MADE for a relationship with Jesus
• and MADE to love others.

This summer, discover how the Creator of all things created us to know and love Him.

Memory Verse: “Let your light shine so others can see it. Then they will see the good
things you do. And they will bring glory to your Father who is in heaven.” Matthew 5:16 (NIrV)!

July 24th-28th
6:00 PM– 8:30 PM

Ages 3 thru exiting 5th Grade

$10 Suggested Donation

Register on line
www.tfbclife.org
Questions call 310.922.5652

On July 24th please plan on arriving at 5:45 PM.

Email address
CHILD ONE
Child’s First Name:
Sylvia
Your answer
Child’s Last Name:
Earle
Your answer
Child's Birth Date:
8/30/1935
MM
/
DD
/
YYYY
Present Age
Your answer
Grade Entering:
Your answer
Special Needs/Allergies/Health Conditions Information:
Your answer
I permit my child’s name and food allergy to be posted for VBS staff members to see.
CHILD TWO
Child's First Name
Reid
Your answer
Child's Last Name
Stowe
Your answer
Child's Birth Date:
1/6/1952
MM
/
DD
/
YYYY
Present Age
Your answer
Grade Entereing
Your answer
Special Needs/Allergy/Health Conditions Information:
Your answer
I permit my child’s name and food allergy to be posted for VBS staff members to see.
CHILD THREE
Child's First Name
Kira
Your answer
Child's Last Name
Salak
Your answer
Child's Birth Date:
9/4/1971
MM
/
DD
/
YYYY
Present Age
Your answer
Grade Entering
Your answer
Special Needs/Allergy/Health Conditions Information:
Your answer
I permit my child’s name and food allergy to be posted for VBS staff members to see
CHILD FOUR
Child's First Name
Anthony
Your answer
Child's Last Name
Bourdain
Your answer
Child's Birth Date:
6/25/1956
MM
/
DD
/
YYYY
Present Age
Your answer
Grade Entering
Your answer
Special Needs/Allergy/Health Conditions Information:
Your answer
I permit my child’s name and food allergy to be posted for VBS staff members to
Parents'/Guardians' Name
Your answer
Home Street Address
123 Sesame Street
Your answer
City
Your answer
Zip Code
Your answer
Main Phone Number. Either HOME or CELL
Your answer
Other Contact Number
Your answer
Email (this will only be used for VBS reasons)
Your answer
Emergency Contact Name & Number
Your answer
Emergency Contact Relationship:
Your answer
What church do you regularly attend? If none mark none
Your answer
I acknowledge that my child’s photographs may be used in any responsible fashion, by First Baptist Church of Torrance, in its sole discretion, including but not limited to publications, videos, and websites. Please check the box that applies:
Shirt Size (sizes)
Your answer
Release of First Baptist Church of Torrance: I shall indemnify, hold free and harmless, assume liability for, and defend First Baptist Church of Torrance,its agents, servants, employees, officers, and directors from any and all costs and expenses including but not limited to, medical costs, attorney’s fees, reasonable investigative and discovery costs, court costs, and all other sums which First Baptist Church of Torrance, assertion of liability, or any claim or action founded thereon, arising or alleged to have arisen out of my child(ren) use of real or personal property belonging to First Baptist Church of Torrance, as agents, servants,employees, officers, and directors, or by action or omission by my child(ren)
Authorization of Consent to Treatment: I  We, the undersigned, parent(s)/guardian of child(ren) listed above, do hereby authorize First Baptist Church of Torrance Children’s Ministry leaders as agent(s) for the undersigned to consent to any dental care, x-ray examination,anesthetic, medical or surgical diagnosis or treatment, and hospital care which is deemed advisable by, and is to be rendered under the general or specific supervision of any physician and surgeon licensed under the provision of the Medical Practice Act, whether such diagnosis or treatment is rendered at the office of said physician or at a hospital.It is understood that this authorization is given in advance of any specific diagnosis, treatment,or hospital care being required, but is given to provide authority and power on the part of our aforesaid agent(s) to give specific consent to any and all such diagnosis treatment or hospital care which the aforementioned physician in the exercise of his best judgment may deem advisable. This form is for any and all events, projects, ministries, small groups or trips involving First Baptist Church of Torrance. It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care being required. The above authorization is given pursuant to the provisions of Section 25.8 of the Civil Code of California, and shall remain effective through the above named minor’s graduation from high school, unless sooner revoked in writing delivered to said agent(s).
Parent’s or Guardian’s Signature (Initials)
H20
Your answer
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