VBS 2025 Student Registration

This address will receive a confirmation email

Student Information

Child's Name

Birth Date (MM/DD/YYYY)

As of 9/1/2024

Child's Age

5 6 7 8 9 10 11 Other

Does your child attend church?

Yes No

If so, where?

Medical Information

List any food or life threatening ALLERGIES. (If none, please type NONE.)

Please check any (life-threatening) medical conditions that the child has.

NONE Seizures Asthma Heart Condition Other

If "other", please explain.

Please check any learning or behavior conditions that the child has. (This is to help our leaders serve your child well during their time with us.)

NONE ADHD/ADD Sensory Processing Disorder ASD (Autism Spectrum Disorder) Dyslexia Other

If "other", please explain.

Does the child require life-saving medication to be on-site during VBS each night?

Yes No

If life-saving medication is required to be on-site, a member of our team will be in touch to collect it prior to your child's attendance.

Please share any additional medical/learning/behavior information that would be helpful to our team.

The following information should apply to this student's registration and ALL siblings registrations connected to this student.

Parent Contact

Phone

Address

Emergency Contact (Different from Parent Listed Above)

Emergency Contact #1

Phone Number

Emergency Contact #2

Phone Number

Dismissal Information

Please only list names of those NOT listed above who are approved to pick up your child at the end of VBS each night?

Consent for Participation

My child(ren) has (have) permission to engage in all prescribed event activities which may include rigorous indoor and outdoor activities, unless otherwise noted by me, the parent or legal guardian.

I agree

Northwood Baptist Church has my permission to use my or my child(ten)’s photograph publically to promote the church. I understand that my child(ten)'s photo may be taken and the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use.

I agree

Northwood Baptist Church is a non-profit charitable organization dependent on God and his people. Those who engage in any related activities waive and release Northwood Baptist Church from any claim for personal injury, illness, or property damage.

I agree

I, _______________________, agree and understand that by signing the Electronic Signature Acknowledgment and Consent Form, that all electronic signatures are the legal equivalent of my manual/handwritten signature and I consent to be legally bound to this agreement. I further agree my signature on this document is as valid as if I signed the document in writing. This is to be used in conjunction with the use of electronic signatures on all forms regarding any and all future documentation (i.e., sibling registrations) with a signature requirement, should I elect to have signed electronically.

Parent/Guardian Electronic Signature

VBS 2025 Student Registration

Description

Please Fix the Following