2022 VBS Registration Form

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Registration form for the 2022 Summer Vacation Bible School between June 20 - June 24, 2022.
First Baptist Church & University Baptist Church, 2800 University Dr., Charleston, IL 61920

Parent/Legal Guardian *

Address *

Parent/Legal Guardian's Phone number *

Contact e-mail (If there is no email available, please type "None". *

Child's Name *

Child's age *

Child's Last Grade Completed *

Pre-K

First

Second

Third

Fourth

Fifth

Sixth

T-Shirt size *

7/8

10/12

14/16

Adult S

Adult M

Adult L

Other:

Emergency Contact Name, Number and relationship to child *

Allergies: (If no allergies, reply "None") *

Any medical diagnosis or special concerns: (If there are no concerns, reply "None") *

I give First Baptist Church/University Baptist Church permission to use my child’s picture on church affiliated websites. *

Yes

I give my child permission to ride in the UBC church van. *

Yes

In the case of an emergency, we will make every effort possible to reach the child’s parent/legal guardian but in the instance, you cannot be reached, by signing below you give FBC/UBC permission to seek medical care as deemed necessary by the orders of a licensed physician. By signing below you also agree not to hold any FBC/UBC representative liable for any illness or medical emergency that may occur while attending VBS and agree to cover all medical expenses occurred with your child. (Please type your signature, provide your email, and date below.) *

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