Ascension Baptist Church - Vacation Bible School

Family Vacation Bible School Registration

Adult T-shirt Sizes:

Child T-shirt sizes:

Mark each child size needed

Small

Medium

Large

If you need more than one shirt of the same size please list below:

Family Information:

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Preferred Email

Preferred Phone Number

Child's Information:

First Name

Last Name

Birthdate

Grade Completed (Not required for those not in school yet)

Gender

Parent/Guardian Information:

Mother's First Name

Mother's Last Name

Mother's Preferred Phone Number

Father's First Name

Father's Last Name

Father's Preferred Phone Number

Authorized individuals to pick-up my child: (Must be 18 years of age or older).

Medical History:

Are there any food, animal, or other allergies we need to be aware of?

Are there any special needs/medical concerns/other considerations we need to be aware of?

Emergency Contact Information

First Name

Last Name

Relation to Child:

Preferred Phone Number

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Media/Photo Release Form:

Media Release

Yes (Sign Below)

No

I hereby give permission for Ascension Baptist Church (ABC) to use mine or my child's photograph (without their name) in ABC publications, on the website, and in news releases in regard to any ABC sponsored activity.

Signature

Today's Date

Family Vacation Bible School Registration

Adult T-shirt Sizes:

Child T-shirt sizes:

Family Information:

Child's Information:

Parent/Guardian Information:

Medical History:

Emergency Contact Information

Media/Photo Release Form:

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