Vacation Bible School Sign-Up Parkview Baptist Church

THE TIME HAS COME TO LEVEL UP

– VBS 2023 is happening July 17th – July 21st –

6:00 PM – 8:00 PM Every Night

Let’s see if you can bring you A-Game, beat the clock, and be ready to play…will you win? Register now!

*Register by July 3, 2023 in order to receive a FREE T-shirt!

Rising Kindergarten (must be 5 years old) to Rising 5th Graders welcome!

*DOORS OPEN 10 MINUTES EARLY*

Registration cost: FREE

Please fill out the form below completely for EACH child participating.

*Denotes required field

Vacation Bible School 2023

Participant Information

Participant Name *

Age *

Participant T-Shirt Size *

Grade Completed in Spring 2023 *

Date of Birth *

Parent/Legal Guardian Information

*Note: This contact information will be used in the case of an emergency.*

Parent/Legal Guardian Name *

Relationship To Participant *

Email Address *

Home Phone Number *

Work Phone Number

Cell Phone Number *

Street Address *

City *

State *

Zip Code *

Medical Profile

Generally, the participant's health is: *

Please explain the participant’s condition:

List any medical difficulties for which the participant is being treated:

Please Explain:

List any medicines or substances to which the participant is allergic: *

List any previous operations or serious illnesses:

List any medications the participant takes:

List any special diets or needs:

Date of last tetanus immunization

Family Physician

Phone Number

Insurance Company

Phone Number

Subscriber Name

Subscriber Number

Place of Employment

Phone Number

Subscriber Occupation

Permission for Medical Treatment, Photograph/Video Notice and Release and Indemnity

My permission is granted for the camp or event director, church official, any camp or event staffer, or adult present or in charge of First Aid to obtain necessary medical attention in case of sickness or injury to my child. Also, I understand that as a participant, my child may be photographed or videotaped during normal camp or event activities and these photos/videos may be used in promotional materials. I, the undersigned, do hereby verify that the above information is correct and I do hereby release and forever discharge Parkview Baptist Church from any and all claims, demands, actions or causes of action, past, present or future, arising out of any damage or injury while participating in this camp.

I agree *

I Agree