SMBC Vacation Bible School 2021
Children, ages 4 years old (as of 1/1/2021) through completed 5th grade are invited to join us for 4 days of fun (and it's FREE)!  We will have a kick-off event on Sunday, August 8 @ 5 PM in the SMBC Sanctuary.  VBS t-shirts will be provided FREE to pre-registered children at the kick-off event (while supplies last!).   Space is limited so please pre-register! Online VBS Registration Form must be completed by a Parent/Guardian for EACH child attending.
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Child's Name (First, Last) *
Birth Date (Must be 4 years old by 1/1/21) *
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Street Address *
City *
State *
Zip Code *
Parent's Cell Phone *
Can this cell phone receive texts? *
Email Address *
Parent/Guardian Name (that is completing this form) *
Emergency Contact (Name and Phone Number) *
Allergies, medical concerns, medications and/or special needs:
School Grade (Completed in 20-21 School Year) *
Name of church you attend, if any: *
I hereby grant Smith Memorial Baptist Church permission to photograph my child for use on crafts, their website, and/or informational/ promotional purposes (no names or personal information will ever be used). *
Do you agree to the following statement:  I , the parent(s) or guardian(s) of the child registered for SMBC Vacation Bible School August 9-12, 2021, do hereby authorize adult volunteers of Smith Memorial Baptist Church as agent(s) for the parent/guardian, to consent to any medical or surgical care deemed advisable by any accredited physician or surgeon in an approved emergency clinic or hospital. I further release from any liability Smith Memorial Baptist Church, and any of its ministries or leaders in the event of an accident en route, during and returning from the above mentioned event. This agreement does not apply to claims for intentional misconduct or gross negligence. *
Health Insurance Company Name: *
Insurance Policy Number *
Doctor's Name and Phone Number *
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