VBS 2025 – Bessie Road Baptist Church

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VBS 2025

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Participant Information

Child’s Full Name: *

Nickname (if any):

Date of Birth *

Age: *

Grade Just Completed: *

Select

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Parent/Guardian Information

Parent/Guardian Name(s): *

Primary Phone Number: *

Alternate Phone Number:

Email Address: *

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

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Emergency & Medical Information

Emergency Contact Name (other than parent/guardian): *

Relationship: *

Phone:

Allergies (food, medication, etc.): *

Medical Concerns/Conditions: *

Family Doctor Name & Phone (optional):

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Drop-off & Pick-up

Authorized People to Pick Up Child (must bring ID): *

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Photo/Video Release

Consent *

I grant permission for my child’s photo or video image to be taken during VBS activities and used in church publications, displays, or social media.

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Signature

Consent *

I, the parent or legal guardian of the above-named child, give permission for participation in Vacation Bible School. I release [Church Name] and its representatives from liability for accidents or injuries that may occur.

Parent/Guardian Signature: *