VBS | Maranatha Bible Church

Parent/Guardian First Name

Parent/Guardian Last Name

Address 1

Address 2

Country

City

State

Zip/Postal Code

Email Address

Phone Number

Name of Home Church (Optional):

Emergency Contact Name / Relationship to Child

Emergency Contact Phone Number

List names of other people that can pick up your child, separated by comma:

Child's Full Name

Child's Birth Date (MM/DD/YY)

Child's Gender
Female
Male

Grade Completed?

Any Food Allergies?
Yes
No

If you answered yes to above, please list below:

Medical Concerns?
Yes
No

If you answered yes to above, please explain below:

Special Needs Concern:
Yes
No

If you answered yes to above, please explain below:

Needs 1:1 Assistant?
Yes
No

If you answered yes to above, please explain below:

AUTHORIZATION & RELEASE:

- I give permission for my child to participate in all activities for VBS. - I will submit any essential health information in written form. - I have provided emergency contact information. - I authorize Maranatha Bible Church to administer any first aid or medical treatment necessary. - I release Maranatha Bible Church and all staff from any and all responsibility and liabilities in connection therewith. - I understand that my child’s photo/video may be taken for use in VBS events or promotional purposes unless otherwise stated by me.

Agreement
I have fully read and understood the above AUTHORIZATION & RELEASE, and agree to it.

VBS Signup Form

AUTHORIZATION & RELEASE:

Maranatha Bible Church

Service Times

Contact Info

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