WILD LIVE! VBS Registration 2024

Vacation Bible School Registration

How did you hear about our VBS? *

• Personal Invitation
• Website
• Facebook
• Poster/Advertisement

Parents/Guardian Name *

First

Last

Address *

Address Line 1

Address Line 2

City

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Zip Code

Phone *

Email *

Emergency Contact Name *

First

Last

Phone *

Child/TEEN Name

First

Last

AGE and GRADE in school this FALL

Any food allergies?

• Dairy
• Chocolate
• Gluten
• Nuts

Child/TEEN Name

First

Last

AGE and GRADE in school this FALL

Any food allergies? (copy)

• Dairy
• Chocolate
• Gluten
• Nuts

Child/TEEN Name

First

Last

Any food allergies? (copy)

• Dairy
• Chocolate
• Gluten
• Nuts

AGE and GRADE in school this FALL

Any medical concerns we should be aware of?

I will read and sign the Emergency Contact Form Below. This form is required to be on file at BEREA BAPTIST CHURCH 250 WEST STREET BEREA, OH 44017 while your child/TEEN is attending Vacation Bible School/TEEN program. Typing my name in this field constitutes an electronic signing of my signature. *

• Yes
• No

I give permission for my ward to take part in Brea Baptist Church Activities and agree that the leadership team of Berea Baptist Church will not be held responsible for any injuries or illnesses that my ward sustains at a Berea Baptist Church activity. I hereby authorize an adult leader of Berea Baptist Church to act as an agent of myself, in seeking emergency medical treatment, if deemed necessary for my ward(s). In the event that I cannot be contacted in an emergency, I authorize the physician or hospital selected by the leader to provide treatment, including hospitalization, for my ward(s). I also surrender my ward's legal right to their electronic image, and permit usage of it/them for the churches in house presentations/website. *

Submit