VBS REGISTRATION 2019
Event Date: June 17th - 21st
Event Time: 6:00 to 8:30 PM
Event Address: Calvary Baptist Church 804 US Hwy 60 West, Republic, MO 65738
Contact us at (417) 732-1405 or www.calvarymo.com
Child's Name *
First and Last Name
Your answer
Gender *
Child's Birthdate *
MM
/
DD
/
YYYY
Child's Age *
Must be 3 years old by January 31, 2019 to be able to participate.
Grade just COMPLETED *
Does your chid have any allergies, medical concerns or special needs that we need to be aware of? *
If YES, please explain:
Your answer
Parent's / Guardian's Name *
First and Last Name
Your answer
Street Address, City and Zip *
Please give complete address.
Your answer
Best Phone Number to Contact *
Your answer
Email Address *
Your answer
Do you currently have a church home? *
If YES, which church do you attend?
Your answer
Emergency Contacts (in the event a parent can't be reached) *
Please list first and last name, best phone number to contact and relationship to the child.
Your answer
I authorize the following people to pick up my child after VBS *
Other than parents/guardians listed above. Anyone not listed, will not be allowed to pick up your child.
Your answer
Is there anyone NOT authorized to pick up your child? *
If YES, please list their full names:
Your answer
Will your child need transportation? *
If yes, you must live within a 5 mile radius of Calvary Baptist Church and have no other means of transportation to the church. A permission form to ride the van must be filled out and signed before we can provide transportation. No child will be picked up or taken home without a signed permission form. Forms are located in the church office.
Will your family be joining us for dinner from 5:15 to 5:45? *
A child must have a parent or guardian with them during the entire meal.
How many people will be joining us for dinner each night? *
To help us know how much food to prepare, please let us know how many people will be joining us for dinner.
I give permission for photographs or digital images to be taken of my child and understand that they are the property of Calvary Baptist Church and may be used by the church for church purposes and publications including its webite. *
In the event that I cannot be reached in an EMERGENCY, I hereby give permission to the physician selected by the director of Children's Ministry to hospitalize, secure proper treatment for, and order injections, anesthesia or surgery for my child as named above. *
Parent/Guardian Signature and Date *
Your answer
Parent/Guardian Signature and Date *
I, the undersigned, give permission for my child to participate in the above named activity and releases Calvary Baptist Church, its officers, employees, and agents from any liability whatsoever for any injury or death to person or loss or damage to property sustained by the undersigned for any member of his family, in attendance, and the undersigned agrees to defend and indemnify Calvary Baptist Church, its officers, employees, and agents from any liability or loss they might sustain by reason thereof.
Your answer
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