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Registration Form for Vacation Bible School 2008

Email address
Date of birth / /
Phone - -
Street / PO Box
City / State / ZIP
Father's Info
Name
Home Phone - -
Work Phone - -
Cell/Pager - -
Mother's Info
Name
Home Phone - -
Work Phone - -
Cell/Pager - -
Name of church child attends
Emergency Contact
Emergency Phone - -
 
Authorization for Emergency Medical Attention
In the event that I cannot be reached to make arrangements for emergency medical attention, I authorize the person in charge to take my child to:
Name of Licensed Physician
Physician Phone - -
Street / PO Box
City / State / ZIP
OR TO
Name of Hospital or Clinic
Hospital Phone - -
Street / PO Box
City / State / ZIP
OR
The nearest hospital
I give my consent for necessary emergency treatment
 

By digitally signing my name below I certify that I am the child's parent or legal guardian and that I give my permission for my child to take part in all Vacation Bible School activities and absolve the church from liability to me or my child because of any injury to my child at Vacation Bible School or during any Vacation Bible School activity. In the event that I cannot be reached to make arrangements for emergency medical attention, the person designated by Anchor Baptist Church may authorize necessary emergency medical treatment and transportation.

 
(Type your name)
 
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