Child's Name *

First Name

Last Name

Child's Date of Birth

MM

DD

YYYY

Parent/Guardian Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact

If different than parent/guardian

First Name

Last Name

Relationship to Child

First Name

Last Name

Pickup Authorization *

List the names of those who are authorized to pick-up your child after the daily events of VBS have concluded. Those who are authorized to pick-up your child must present valid identification in order for your child to be released into their control. If you give permission for your child to walk home, please type "walk" in the first and last name of the first entry below.

First Name

Last Name

Medical Waiver *

By checking the box below, I authorize the leadership of New Hope Independent Baptist Church to care for the administration of first aid treatment for any minor injuries my child receives during the event. If the injury sustained is life threatening, or in need of emergency treatment, I authorize the leadership of New Hope Independent Baptist Church to summon any or all professional emergency personnel to attend, transport and treat my child. I agree not to hold any staff, assistants, and volunteer workers of Calvary Baptist Church liable for any and all claims, suits, and actions of any kind whatsoever, arising from their exercise of the power granted by this authorization.

I have read and agree to the Medical Waiver

Personal Electronic Waiver and Photo Release Consent *

We ask that cell phones or other personal electronics not be brought to Vacation Bible School. However, if a student needs to bring their cell phone, New Hope Independent Baptist Church and/or its staff is not responsible for any lost or damaged devices due to a child’s negligence or any other situation. If the usage of a device is abused, the child may be asked to surrender the device to a worker, who will return the device after VBS has concluded. I give New Hope Independent Baptist Church permission to use my child’s picture on the church’s printed material, website, or social media. I understand that if I give notice to the webmaster that I object to any picture on the website or social media, that it will be removed as soon as possible. By checking the box below, I agree to the Personal Electronic Waiver and give consent to the Photo Release policy.

I have read and agree to the Personal Electronic Waiver and Photo Release Consent