Parent/Guardian's Name *

Phone *

Email *

Emergency Contact *

Emergency Contact Phone *

Do you have a church home?

Are there any custody, safety, or pickup concerns we should be aware of regarding your child? if yes, please explain below.

Vacation Bible School

Ages 5 to 12

Child 1

Child Name 1 *

Child Age 1 *

Child Allergies 1 *

Child 2

Child Name 2

Child Age 2

Child Allergies 2

Child 3

Child Name 3

Child Age 3

Child Allergies 3

Child 4

Child Name 4

Child Age 4

Child Allergies 4

Child 5

Child Name 5

Child Age 5

Child Allergies 5

I understand that participation in church activities involves normal physical activity and I release Eastside Baptist Church from liability for ordinary accidents or injuries that may occur during VBS activities.

I give permission for Eastside Baptist Church staff and volunteers to obtain emergency medical treatment for my child if I cannot be reached immediately.

I give permission for Eastside Baptist Church to use photos or video taken during VBS for church promotions, social media, and ministry purposes.

Yes

No

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