VBS SCUBA Registration Form June 2024
Name of Child
*
Birth Date
*
Gender
*
Please select one option.
Male
Female
T-Shirt Size
*
Please select one option.
Child's XS
Child's S
Child's M
Child's L
Child's XL
Small Adult
M Adult
L Adult
XL Adult
Grade Completed by May 31st.
*
Have you previously attended VBS @ Hopewell Baptist?
*
Please select one option.
Yes
No
Home Church, If any...
Parent/Caregiver Email
*
This address will receive a confirmation email
Cell Phone (s)
*
Home Address
*
--
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
MEDICAL: Does your child have any allergies? Please List Each or N/A for None
*
Please select one option.
Allergies?
Does your child carry an EPI-Pen?
* NOTE: It is the parent/caregiver's responsibility to ensure the child has the epi-pen at every drop-off and pick-up
NONE
Select Option
Allergies?
Does your child carry an EPI-Pen?
* NOTE: It is the parent/caregiver's responsibility to ensure the child has the epi-pen at every drop-off and pick-up
NONE
Do you have other children attending VBS ?
Please select one option.
Yes
No
IF YES...Please list each NAME, DOB, ALLERGIES
*
ER CONTACTS: Please list the first/last names + Cell Number or ALL adults who are allowed to pick up your child. Your child will only be released to these people.
*
Does your child /children have any other Medical Concerns?
*
Please select one option.
Yes
No
Select Option
Yes
No
If you answered YES to the above question...please detail the concerns below.
*
Is there anything else you want us to know about your child/children? Please describe below.
ADDITIONAL INFO: VBS Photo/videos are taken for promotional purposes related to HBC and VBS. These pictures appear in various media outlets such as The News, Facebook, and/or our webpage. DO YOU ALLOW YOUR CHILD TO BE INCLUDED IN THESE PHOTOS/VIDEOS?
*
Please select all that apply.
YES
NO
By submitting this form, you agree and acknowledge that you have read and understand the above information.
*
Please select all that apply.
Yes
Initials/Date Below:
*
Submit
Description
×
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