Vacation Bible School / Mother's Day Out Summer Program 2019
Questions? Please contact the Church office at 281-342-8664.
Registration and Contacts
Please select a registration type and provide basic contact information.
This Registration is for:
VBS, no fee - for children entering kindergarten through entering grade 6: July 8 - 11 (Monday-Thursday 9:00am – 12:00pm)
MDO Summer Program, $100 with $50 nonrefundable deposit to secure registration - for Infants (up to 9 months) to Pre-K:July 8 - 11 (Monday-Thursday 9:00am – 12:00pm)
Parent or Guardian's Name
Primary Contact Phone
Please tell us about your child and share any special requirements.
Date of Birth
Entering Grade (Fall of 2019)
Name of Child's Church
Allergies or concerns?
I hereby give permission to First Baptist Church to photograph my child/children during MDO/VBS summer program for viewing with families, friends and the general public. Names of children do not appear with their picture.
Publicity release acceptance:
Photos of my child/children may be used for
First Baptist Church website
I hereby give permission for the child listed in this registration to participate in all activities. In addition, my child/children has permission to leave school/church with the following individuals (please enter name and phone # for each contact on separate lines)
Contact in case of an emergency when parents cannot be reached:
Contact Relationship to Child
I hereby agree that in case of illness or accident requiring a physician's immediate attention, and if I cannot be contacted by the school/church, the following physician may be contacted and is authorized to treat my child.
If the above doctor cannot be reached, I give permission for a doctor designated by the program to administer treatment at my expense. I understand and accept the policies above and release the school/church from liability for injury or
illness resulting under all circumstances save gross negligence.
Insurance Provider Name
Insurance Provider Phone
Insurance ID # or Group #
Please type your name to digitally sign this form and authorization.
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