Build Your Life VBS

Child's Full Name

Gender

Birthdate MM/DD/YYYY

Which age group?

Known Allergies or Other Medical Concerns

Hospital of Choice

Parent/Guardian's Full Name

Address

Parent's Phone

Parent's Email

This address will receive a confirmation email

Second Parent/Guardian's Full Name

Second Parent/Guardian's Phone

Second Parent/Guardian's Email

Emergency Contact (If Parent Can't Be Reached)

Emergency Contact Relationship

Emergency Contact Phone

Is FBC your home church?

If not, what church do you attend?

Child's T-Shirt Size

Youth XS Youth S Youth M Youth L Adult XS Adult S Adult M Adult L

Payment (helps cover cost of shirt) $5

RELEASE: I hereby release and agree to hold harmless First Baptist Church at Savoy (FBC-CS) and designated leaders from all liability for damage, illness, or injury. In case of emergency, I give my permission for any necessary medical treatment. I will not hold FBC-CS or any leader/staff persons responsible for any injury that may occur. I also give my permission to FBC-CS to use photos of my children, without any identification, in publications and/or on their website for promotional purposes.

I Agree

Parent/Guardian Electronic Signature (Type Full Name)

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Build Your Life VBS

Description

Please Fix the Following