Vacation Bible School

Vacation Bible School - June 11-13, 2025
6:00-8:00 PM

* Indicates required field

Parent Name *

First

Last

Parent Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Parent Email *

Please complete the following section for each child you are registering. If you are only registering one (1) child, leave the extra boxes blank.

**If you are registering more than three (3) children, please complete another form after submitting this one.**

Child 1 *

First

Last

Child 1 Date of Birth (MM/DD/YYYY) *

Child 1 Age *

Child 2 *

First

Last

Child 2 Date of Birth (MM/DD/YYYY) *

Child 2 Age *

Child 3 *

First

Last

Child 3 Date of Birth (MM/DD/YYYY) *

Child 3 Age *

Emergency Contact Name *

First

Last

Emergency Contact Phone Number *

Please list any allergies that you child(ren) has (if there are no allergies, please put "N/A".

Allergies *

Please list any medical or special needs, including medications currently being used by any of the children you are registering. If none, please put "N/A".

Special Considerations *

Liability Release

I (We), the parent(s) or guardian(s) of the above listed child(ren) grant permission for our child(ren) to participate in Vacation Bible School at Central Bible Chapel and to receive medical treatment if necessary. I (We) also release and agree to hold harmless Central Bible Chapel and all its participants from any liability and assume all risk of injury, damage, or expense as the result of participation in actives in Vacation Bible School. By entering my name and the date below I am signing in agreement to the Liability Release.

Parent/Guardian Name - Liability Release *

First

Last

Liability Release Date *

Photo Permission

I (We), the parent(s) or guardian(s) of the above listed child(ren) grant permission for our child(ren) to have their picture taken during Vacation Bible School at Central Bible Chapel and for their image to be used in crafts or promotions. By entering my name and the date below I am signing in agreement to the Photo Permission. By entering "N/A" for my first and last names, I am indicating that Central Bible Chapel does not have permission to photograph my child(ren).

Parent/Guardian Name - Photo Permission *

First

Last

Photo Permission Date *

Submit