VBS Registration

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? *

Emergency Contact Name *

First

Last

Emergency Contact Phone *

May this person pick up your child(ren)? *

Relationship to Child *

Child 1 Name *

Age *

Last Grade Completed *

Gender *

Birth Date *

Child 2 Name *

Age *

Last Grade Completed *

Gender *

Birth Date *

Child 3 Name *

Age *

Last Grade Completed *

Gender *

Birth Date *

Child 4 Name *

Age *

Last Grade Completed *

Gender *

Birth Date *

Child 5 Name *

Age *

Last Grade Completed *

Gender *

Birth Date *

Child 6 Name *

Age *

Last Grade Completed *

Gender *

Birth Date *

Allergies/Medical Conditions *

How did you hear about VBS at Maranatha? *

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