Vacation Bible School Registration Form

The Rock Prairie Baptist Church Vacation Bible School Registration Form may be (1) filled out online and submitted electronically or (2) picked up at the church and filled out on the morning of June 1st.  For safety reasons, children cannot be dropped off outside.  Parents/guardians must accompany the child(ren) into the church foyer.

Thank you!

Child's Name:*
Date of Birth (mm/dd/yyyy):*
Child's Age:*
Grade Completed at time of VBS:*
Parent/Guardian Name:*
Address:*
Primary Phone:*
-
Alternate Phone:
-
E-mail:*
E-mail confirmation:*
Has child attended VBS here before?*
How did you hear about this VBS?*
Home Church:
Anyone NOT authorized to pick up child:*
Emergency Contact Name:*
Relationship:*
Emergency Contact Phone:*
-
Does child have allergies? *
List allergies, current medications, and physical impairments to which a physician should be alerted:

RELEASE AND CONSENT

I, the undersigned, as the parent or legal guardian of the named child, do hereby give permission for him/her to participate in any of the activities conducted during VBS at Rock Prairie Baptist Church.
Liability Release: I hereby release, forever discharge and agree to hold harmless the Rock Prairie Baptist Church and the directors thereof from any and all liability, claims, or demands for personal injury sickness or death, as well as property damage and expenses of any nature which may be incurred by the undersigned and the above named child that occur during all activities during the Rock Prairie Baptist Church VBS.*
Consent for photographs & videos: I hereby authorize and give full consent, without limitations or reservations, to Rock Prairie Baptist Church to publish any photographs or videos in which the above named child will appear while participating in any program with Rock Prairie Baptist Church. There will be no compensation for use of any photographs or videos at the time of publication or in the future.*
Medical Release: Should any accident or illness occur during the Rock Prairie Baptist Church VBS, I will not hold the church or its directors responsible for medical aid rendered and will reimburse them for the medical and other expenses incurred. The above named child may receive necessary first aid. He/she may receive medical attention by any duly licensed physician, and may be admitted into a hospital in case of an emergency.*
GDPR Statement: Information submitted through this registration form will be used for registration purposes. It will not be retained on this website nor will it be transferred via any means to 3rd parties. Rock Prairie Baptist Church may, at its discretion, send out periodic emails or letters as follow-up to this event or others in the future. If you wish NOT to be contacted, you may opt out below.
Parent/Guardian name serves as an electronic signature.*
Today's Date:*
Word Verification: