VBS Registration
Clarke-Venable's Vacation Bible School is June 3-7, 2024 and runs from 8:30am to 12:00pm.
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Please complete one form per participant.
VBS Participant's Name & Info
Child's First Name *
Child's Last Name *
Gender *
Date of Birth *
MM
/
DD
/
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Select Grade completed by June 1, 2024 *
Child must be 3 years old by September 1, 2023 to attend VBS.
Parent/Guardian's Name *
Parent/Guardian's Cell Number *
Format Example:  601-123-4567
Email address *
Participant's Address
Address *
City *
State *
Postal / Zip Code *
Allergies & Emergency Contact
Allergies, Medical, & Special Needs
Leave Blank if None
Who is authorized to pick up this participant? *
Please provide the first and last name.
Emergency Contact Name *
Emergency Contact Phone *
Format Example:  601-123-4567
Medical and Liability Release (Please read the following)
I understand that in the event my student requires medical or dental treatment while engaged in activities with Clarke-Venable Baptist Church, reasonable efforts will be made to contact me; if I cannot be reached, I hereby consent and give permission to the ministry's sponsor or any adult sponsor acting on behalf of the ministry with respect to church activities as agent for me.  I understand all reasonable safety precautions will be taken at all times by Clarke-Venable Baptist Church and its agents during the events and activities.  I understand the possibility of unforeseen hazards and know the inherent possibility of risks.  I agree not to hold Clarke-Venable Baptist Church, its leaders, employees, land owners, and volunteer staff liable for damages, losses, diseases, or injuries incurred by this student.
Do you consent to the above statements? *
Required
Media Release (Please read the following)
I hereby consent to the use of any video images, photographs, audio recordings, or any other visual or audio reproduction that may be taken of this student during the event to be used, distributed, or shown as Clarke-Venable Baptist Church sees fit.
Do you agree to the statement above? *
Required
Parent/Guardian Digital Signature *
By Clicking yes I agree that this is my signature *
Required
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