Page 128 | Providence Baptist Church

Child's Sponsor (Required)

Relationship to Child

E-Mail (Required)

Child's Name (Required)

Age (Required)

Last Grade Completed (Enter None if Child hasn't attended school) (Required)

Street Address (Required)

City (Required)

State (Required)

Zip Code (Required)

Phone Number (Required)

Additional Emergency Contact Name

Additional Emergency Contact Number

Alternate Pick-Up Name(s)

Permission to Attend: (Required)

I give permission for my child (named above) to attend the Vacation Bible School (VBS) listed above. I understand that the information I give for this registration will only be used by the VBS hosting church.

Medical Release: (Required)

I give my permission for the VBS staff to administer basic first aid to my child (named above) in the event of an injury. I understand that the VBS staff will contact me but may also contact emergency services in the event of a significant injury, and all expenses for such emergency services will be paid by me.

Photo Release: (Required)

I hereby grant VBS staff permission to take photographs and videos of my child (named above). Photographs may be posted on the church’s Facebook page without the child’s name.

If you are unable to transport your child and live within the town limits, would you like to request transporation via the church van?

I give my child permission to ride the church van with an accredited driver. I certify that my child meets legal requirements for riding without a car seat.

Solve 2 + 7 = ?

Providence Baptist Church

10 Providence Lane, Daleville, AL 36322

334-598-4987

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