VACATION BIBLE SCHOOL registration form

this program runs from July 29 - August 1, 2019

6:30 pm - 8:30 pm

please note: to register your child must have completed Kindergarten - 5th grade.

Child's Name *
Child's Name
Date of Birth
Date of Birth
M/F
Last Grade Child Completed *
Parent/Guardian
Parent/Guardian
Home Address
Home Address
Home Phone
Home Phone
Cell Phone
Cell Phone
Work Phone
Work Phone
Does your child have any allergies or other conditions we should be aware of?
Emergency Contact
Emergency Contact
Phone
Phone
LIABILITY/MEDICAL RELEASE: In the event of an emergency, where medical treatment is required, I give permission to Tracy Community Church staff to obtain the service of a licensed physician and/or hospital as it relates to the registered child. Please attempt to notify me immediately concerning such an emergency. I understand that Tracy Community Church is not liable for any accidents, illnesses or any other problems, damages, costs incurred by or to my child. I release Tracy Community Church from all responsibility for any accidents, illnesses or any other problems, damages or costs incurred by or to my child.
PERMISSION FOR PHOTOGRAPHY USE: I understand that during VBS my child may be photographed and/or videotaped. By signing this form I am providing permission for my child to appear in photographs and/or videotape that may be shown on our website or social media sites.