Register for VBS

Family Information

Address

Primary Phone

Alternate Phone

Relationship to Student Father Mother Grandfather Grandmother Great-grandfather Great-grandmother Brother Sister Uncle Aunt Guardian Foster Parent Granduncle Grandaunt Other

Phone Number

Student Information

Gender

Birth Date

Age Group

Food Allergies

Details

Medical Concerns

Details

By checking this box I acknowledge that I have read and understand the below: I am the parent or legal guardian of the above named child and I give permission for my child to attend Vacation Bible School at Ewell Bible Baptist Church and participate in all activities. I authorize all medical, surgical, diagnostic, and hospital care or procedures which may be performed or prescribes for the above named child by a licensed physician or hospital, when efforts to contact me are unsuccessful and when deemed immediately necessary or advisable by the physician to safeguard my child’s health.I acknowledge that Ewell Bible Baptist Church will not be responsible for medical expenses incurred. I give permission for the above named child to be photographed during VBS, and for the images to be published, reproduced or distributed by Ewell Bible Baptist Church in all outlets, including, but not limited to, internet and church publications, without liability or limitation on my or my minor’s part. Acknowledgement

My child will be transported by the Boys & Girls Club to Ewell and I have notified the club office of their registration. Boys & Girls Club Students Only

I have more students to register