Vacation Bible School Registration
Child's Name
Gender
Entering Grade
Birth date
Medical Concerns
(Allergies; chronic medical conditions that limit activity; significant emotional, behavioral or physical concerns or limitations)
First
Last
Month
Day
Year
M
F
N/A
K
1
2
3
4
5
6
1
2
3
4
5
6
7
8
9
10
11
12
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Friend with whom to be grouped:
M
F
N/A
K
1
2
3
4
5
6
1
2
3
4
5
6
7
8
9
10
11
12
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Friend with whom to be grouped:
M
F
N/A
K
1
2
3
4
5
6
1
2
3
4
5
6
7
8
9
10
11
12
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Friend with whom to be grouped:
M
F
N/A
K
1
2
3
4
5
6
1
2
3
4
5
6
7
8
9
10
11
12
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Friend with whom to be grouped:
M
F
N/A
K
1
2
3
4
5
6
1
2
3
4
5
6
7
8
9
10
11
12
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Friend with whom to be grouped:
Address
City
State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip
Mother/Guardian
Phone
(
)
–
Email
Father/Guardian
Phone
(
)
–
Email
Emergency Contact 1
Phone
(
)
–
Emergency Contact 2
Phone
(
)
–
First Name Last Name
Who is allowed to pick up your child?
Church home (if applicable):
All information collected by New Life Baptist Church (NLBC) will be used for purposes of Vacation Bible School. We never sell, rent, lease or exchange your personal information with other organizations. Contact information will be added to NLBC's mailing lists to inform you of future programs with NLBC, unless you notify us in writing.
Individual and group photos will be taken of you child(ren) during Vacation Bible School for distribution to the cowpokes and for use at NLBC unless you inform us in writing otherwise.
I, parent or legal guardian of the above named child(ren), all him/her/them to attend Vacation Bible School at NLBC. I recognize the risk involved in activities and will not hold NLBC, its staff or volunteers responsible for any personal injury that might occur to my child(ren) while participating in this program. I authorize a NLBC staff member or volunteer to seek and obtain such emergency or medical services for my child(ren) as deemed necessary at the time.
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