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Vacation Bible School
Registration Form
Liberty Baptist Church, Stephens City, VA
Attendee Information
Registration Type
Select Adult if the registration is for yourself and you are over 18 years old.
Select Child if the registration is for a person under 18 years old and you are their parent or gardian.
Registration Type (Required)
Child
Adult
Note: We provide nursary services for those attending Vacation Bible School.
Attendees Under 18
Age (Required)
Select Age
Pre-K
5 Years Old
6 Years Old
7 Years Old
8 Years Old
9 Years Old
10 Years Old
11 Years Old
12 Years Old
13 Years Old
14 Years Old
15 Years Old
16 Years Old
17 Years Old
Highest Grade Completed (Required)
Select Grade
Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Emergency Contact (Required)
Emergency Phone (Required)
Permission for Minor
I give permission for my child to participate in Vacation Bible School at Liberty Baptist Church. I understand that reasonable plans have been met to ensure the safety and welfare of all participants. I also understand that volunteer adults and staff will be chaperoning the event and activities and will take reasonable actions as they deem necessary to protect the best interest of all participants. My child agrees to conduct himself/herself in a safe and orderly manner and will cooperate/comply with decisions made by adult chaperones. I hereby authorize a representative of liberty Baptist Church to consent to an authorized emergency medical treatment, surgery, or dental care to be given to my son/daughter as considered advisable or necessary in the judgment of emergency medical professional or attending physician if I cannot be reached or am not present. If I have any specific medical considerations that should be met, I will document them below. By placing a check in the block below, I agree that I have read and understand the conditions described above and give permission for my child to participate in Vacation Bible School at Liberty Baptist Church. By checking this box I am agreeing to the requirements above and giving permission for my child.
Grant Permission
Yes
All Attendees
I/my child will attend on the following days: (Required)
Monday
Tuesday
Wednesday
Thursday
Friday
Please add any allergies and/or special accommodations below so that we may be able to take steps to accommodate for the need. We cannot guarantee that we can provide for every circumstance, but will do the best we can to meet all special needs. You are not required to disclose or provide any medical or accommodation request information and it will not preclude you/your child from participating; however, we also will not be able to prepare or try to make an accommodation for a condition or allergy issue if we are unaware. Not knowing may hamper your/your Childs involvement and interaction with the program.
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