PIB Vacation Bible School Registration Form 2019
Event Time: June 9th-June 13th, 2019 from 6:30pm-8:30pm
Event Address: 1509 Tarlton Street, Corpus Christi, Texas, 78415
Contact us at: 361-884-3582 & pibcc@sbcglobal.net
Email address *
PLEASE FILL OUT ONE REGISTRAION FORM PER CHILD
Child's Name *
Your answer
Chilld's Age
Your answer
Child's Last Grade Completed
Your answer
Parent/ Guardian Name *
Your answer
Parent/ Guardian Address *
Your answer
Parent/ Guardian Cell Phone Number *
Your answer
Alternate Parent/Guardian Name & Cell Phone
Your answer
Known Food Allergies *
Your answer
LIABILLITY RELEASE On this day, June 9th, 2019 through June 13th, 2019 intending to be legally bound hereby, the undersigned agrees and does hereby release from liability and to indemnify and hold harmless Primera Iglesia Bautista of Corpus Christi, Texas, and any of its employees or agents representing or related to Primera Iglesia Bautista of Corpus Christi, Texas, as regards to the Vacation Bible School Event(s) being completed. This release is for any and all liability for personal injuries, including death, and property losses or damage occasioned by, or in connection with any activity or accommodation for this Vacation Bible School event(s). The undersigned further agrees to abide by all the rules and regulations promulgated by Primera Iglesia Bautista of Corpus Christi, Texas and/or its affiliate groups and vendors throughout this vacation Bible School events(s). *
A copy of your responses will be emailed to the address you provided.
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