Parent/Guardian Name*

First Last

Parent/Guardian Email*

Parent/Guardian Phone*

Parent/Guardian Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Home Church*

How did you hear about VBS*

Parent/Guardian Consent*

Permission Waiver - Please Read

Parent / Guardian Digital Signature - I give my permission for my child named above to participate in Vacation Bible School June 10-14, 2019 at Northwest Valley Baptist Church, and to engage in all Bible and recreational activities that are involved. I realize that photography or videography from this activity may be used in marketing or social media (please communicate with the church office in advance if you would like an exemption). I agree to be responsible for the expense of medical aid where not covered by the accident insurance policy held by Northwest Valley Baptist Church.

Children

Child's Name

First Last

Child's Gender

Child's Grade (Fall 2019)

Child's Birthday

Child's Medical Conditions / Allergies / Activity Restrictions