Maranatha Baptist Church
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Monday - Friday
June 19-23, 2017
6:30-8:00 PM
Family Registration Form
*
Indicates required field
Dad/Guardian Name
*
First
Last
Home Address
*
Line 1
Line 2
City
State
Zip Code
Country
Mom/Guardian Name
*
First
Last
Home Phone Number
*
Cell or Secondary Phone Number
*
Work Phone Number
*
Email
*
Do you attend church?
*
Yes
No
In the past, but not currently.
Emergency Contact Name
*
First
Last
Emergency Contact Phone
*
May this person pick up your child(ren)?
*
Yes
No
Relationship to Child
*
Child 1 Name
*
Age
*
5
6
7
8
9
10
11
Last Grade Completed
*
Gender
*
Boy
Girl
Birth Date
*
Month/Day/Year
Child 2 Name
*
Age
*
5
6
7
8
9
10
11
Last Grade Completed
*
Gender
*
Boy
Girl
Birth Date
*
Month/Day/Year
Child 3 Name
*
Age
*
5
6
7
8
9
10
11
Last Grade Completed
*
Gender
*
Boy
Girl
Birth Date
*
Month/Day/Year
Child 4 Name
*
Age
*
5
6
7
8
9
10
11
Last Grade Completed
*
Gender
*
Boy
Girl
Birth Date
*
Month/Day/Year
Child 5 Name
*
Age
*
5
6
7
8
9
10
11
Last Grade Completed
*
Gender
*
Boy
Girl
Birth Date
*
Month/Day/Year
Child 6 Name
*
Age
*
5
6
7
8
9
10
11
Last Grade Completed
*
Gender
*
Boy
Girl
Birth Date
*
Month/Day/Year
Allergies/Medical Conditions
*
Please list any allergies or medical conditions we should be aware of in regards to each child listed above.
How did you hear about VBS at Maranatha?
*
Our Church Website
Our Church Facebook Page
Daily Herald
Online Calendar
Someone visited my home
A friend invited me
I received an invite via e-mail
I received an invite via postal mail
Check all that apply.
Consent To Participate
I give consent for my child to attend Maranatha Baptist Church’s VBS June 19-23, 2017.
In the event that he/she is injured while under the care of MBC and its representatives and requires the attention of a doctor, I hereby consent to and will be responsible for any reasonable first aid administered by an MBC representative and/or medical treatment as deemed necessary by a licensed physician. I further agree to hold Maranatha Baptist Church and all MBC employees, volunteers and representatives free and harmless of any claims, demands or suits for damages arising from the authorization and provision of such first aid/medical treatment. I understand the nature of the events and do hereby release Maranatha Baptist Church and its representatives from any liability due to accident or injury incurred by my child.
Pictures will be taken during VBS and may appear without names on our Facebook page or our website.
If I am unable to transport my child to or from VBS, I give consent for MBC to transport my child in one of their passenger carrying vans or in a church member’s private vehicle.
Parent/Guardian Name
*
First
Last
Submit
