VACATION BIBLE SCHOOL 2008
June 9th - 14th
8:30 am - noon

Children ages completed Kindergarten thru 5th grade are welcome!
Please sign up each child separately.

                             
Child's Full Name
First Name: Middle Initial:  Last Name:
Female     Male                                                                         
Birthdate dd/mm/yy:       Grade Completed:
School Last Attended:
Home Street Address:
City:   Zip Code:
Email:       
Home Phone:
Work Phone:
Cell Phone:      
Legal Guardian: 
Guardian Home Phone:
Guardian Work Phone:
Guardian Cell Phone:
Do you attend church?  Yes:  No:
Where?
Who can pick up your child at the end of the day?

HISTORY AND HEALTH INFORMATION

Date of last tetanus shot:

Are all other immunizations current?    Yes:   No:

Asthma (Does the child need to keep the inhaler to use as needed?    Yes:  No:

Allergies?  Please List: 

Insect stings / Bites

Diabetes?

Kidney Trouble?

Heart Trouble?

Other? Please List:

Medications? Please List:

PERMISSION FOR MEDICAL TREATMENT & PHOTO / VIDEO NOTICE RELEASE

I am aware that 's participation in all children's related activites through Outrigger Island VBS could involve the risk of injury to my child. To participate in church sponsored activites I hereby agree to let my child participate and to hold Bethany Baptist Church of McDonough, GA, harmeless from any and all liability actions, courses of action, debts, claims, or demands, of any kind and nature whatsoever which may arise by or in connection with my child participating in any activities. Because of the risks involved I will encourage my child to follow the instructions of the supervising adults. My permission is granted for supervising adults to obtain medical and surgical treatment as may be needed in the judgement of the treating physician for my child by a physician chosen by the church chaperone. I also understand that as a participant, my child may be photographed or videotaped during church sponsored activities and thes photo's/videos may be used in promotional materials and/or the church website.

I am signing this on my own free will.

Child's Name:
Parent/Guardian Signature:

Date: