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

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

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

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:

VBS SCUBA Registration Form June 2024

Description

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