VBS Registration

REGISTRATION 2018:
Kingdom Chronicles

PARENT/GUARDIAN INFORMATION

First Name (required)

Last Name (required)

Address (required)

Email (required)

Phone Number (required)

Emergency Contact Number (required)

CHILD'S INFORMATION

Child's First Name (required)

Child's Last Name (required)

Gender (required)

Date of Birth (required)

Allergies (required)YesNo

If yes, please indicate all allgeries

CHILD'S INFORMATION 2

Child's First Name

Child's Last Name

Gender

Date of Birth

Allergies YesNo

If yes, please indicate all allergies

CHILD'S INFORMATION 3

Child's First Name

Child's Last Name

Gender

Date of Birth

Allergies YesNo

If yes, please indicate all allergies

Terms and Conditions
I, the legal parent/guardian listed above, hereby authorize the participation of the above-named child(ren) in activities at Westmount Bible Chapel.

I, the legal parent/guardian listed above, hereby give my permission to the physician, or nurse, selected by Westmount Bible Chapel to secure medical attention as required for illness or injury under a physician’s orders, including transportation to and from the necessary facilities. As a participant, I understand Westmount Bible Chapel is not obligated to carry any insurance to cover those medical expenses.

I, the legal parent/guardian listed above, hereby give permission to have my child, the minor listed above, photographed/filmed for the lawful purpose associated with the VBS program.

I Agree to these Terms (required)
yes