Vacation Bible School Registration

Child's/Youth's Name
Age
Gender
Date of Birth
Current Grade Level (Just completed) :
Address
Parents/Guardians
Primary Email
Alternate Email (if any)
Emergency Contact Name
Emergency Contact Number
Medical Insurance Company:
Any Medical Restrictions from Activities: Any Medications or Food Allergies:
(VBS Staff will not dispense medication.) Any Other Special Needs:
If yes, explain:

I understand that by submitting this form gives permission for my son/daughter to take part in the programs and activities of Vacation Bible School, First Baptist Church of Vienna. I fully recognize that any activity involves an element of risk, and I/we assume responsibility for all risks and hazards incidental to my child's/youth's participation in Vacation Bible School programs and activities. I/we hereby release, absolve, indemnify, and agree to hold harmless First Baptist Church of Vienna, its employees and officers, chairpersons, leaders, organizers, sponsors and persons transporting my/our child/youth to and from this activity. I have read this release, understand all its terms, and execute it voluntarily and with full knowledge of its significance.