Scuba VBS - David Baptist

Scuba VBS * David Baptist

Monday, July 29 - Friday, August 2, 2024 * 6:00 - 8:30 pm
Name*

First NameLast Name
Gender:*

MaleFemale
Date of Birth

MonthDayYear
Date
Last Grade Completed*
For Pre-K, Enter "0"
Name of Home Church
Email
example@example.com
Address*

Street Address

Street Address 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Cell Number

Area CodePhone Number
Emergency Contact Person*

First NameLast Name
Relationship to Child*
Emergency Contact Phone Number*

Area CodePhone Number
Who can pick up your child?*
Allergies or Other Medical Conditions:
I hereby grant permission for David Baptist Church to record sounds, images and/or video of my child, blanks* while attending this VBS Program. I also give permission for David Baptist Church, at its sole discretion, to use these sounds, images and/or videos in publications (including print, websites, and social media platforms) owned by David Baptist Church in relation to this VBS Program.
Signature of Parent/Guardian and Date: blank*
Should be Empty:

Scuba VBS * David Baptist