VBS Registration Form
Child's First Name *
Your answer
Child's Last Name *
Your answer
Child's Gender *
Your answer
Child's Age *
Your answer
Date of Birth *
Your answer
Last School Grade Completed *
Parent's Name *
Your answer
Street Address (including City, State, Zip) *
Your answer
Telephone Number *
Your answer
E-mail Address
Your answer
Home Church
Your answer
Allergies or other Medical Conditions *
Your answer
Emergency Contact (Name and Phone Number) *
Your answer
Emergency Contact's Relationship to Child *
Your answer
This year we will have an organized car line dismissal. Each person picking up a child will receive a number that is linked to that child. Please list the name of the person who will be picking up your child each night. *
Your answer
Photo Release: I hereby allow photographs and video of my child’s participation in First Baptist Church Loxley events to be published via print, video or website which are affiliated with First Baptist Church Loxley. I understand that publications may be accomplished electronically via the Inter-net/World Wide Web, copying my child’s photographs and video there from, and subsequently using, altering or republishing it without my consent. I waive any claim for damages against First Baptist Church Loxley from the un-consented-to use, alteration or republication of my child’s photographs and video by third parties accessing the Internet/World Wide Web or obtaining copies of the print or video material.
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