VBS Registration Form

Please fill out all starred information. ONE FORM PER CHILD. Upon completion, click Submit. If you have any concerns or questions about this form or VBS, we would love to connect with you! Please email us at rockspringsbc747@gmail.com.

VBS Child Registration

Child's Name

First Name

Last Name

Gender

Child's Birthdate

YYYY

Child's Age

Allergies/Medical Conditions

Please include any allergies or sensitivities your child may have. If none, put N/A.

Parent/Guardian

First Name

Last Name

Physical Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number

(###)

###

####

Emergency Contact Phone Number

(###)

###

####

Transportation

How will your child be coming/leaving VBS?

Alternate Pick Up

Please list any alternate names of those who may pick up your child other than yourself. If none, put N/A.

Do you have a home church?

Yes

If so, where?

PLEASE NOTE

Rock Springs Baptist Church (RSBC) will be videotaping and photographing this event. You and/or your child may be filmed, recorded, or photographed as part of a group or individually. By your or your child's attendance at this event, you are granting permission and agree to the following: being videotaped or photographed in the context of this event's activities; any use of your or your child's likeness without compensation; specifically waiving all rights of privacy; and releasing RSBC from liability for loss, damage, or compensation for the use of your or your child's likeness or image. If circumstances exist which make such photography/videography problematic for you or your child, please contact our office to discuss alternative arrangements. If you agree to have you or your child's photo taken please check "yes"

YES