Scuba VBS Registration Form

SCUBA VBS August 5-9, 2024 | It is important that we receive ONE form submission per child so that we can obtain all important information for that child including any allergies, medications, medical conditions, or other information specific to that child.

After submitting the form, a link will be provided for your convenience to return to the form to register an additional child or children.

Thank you in advance.
Child's Information
The below fields are for you to enter the child's information. 
Please submit one form for each child.
There will be an area later in this form for parent/guardian information.
 
 
 
Please select one option.
 
Select the grade your child will be entering in the fall.
Please select one option.
 
What pertinent allergies (especially food allergies) and other medical issues do we need to be aware of?
 
Parent/Guardian Information
Please be as thorough as possible so that we may be able to contact you and keep you updated with changes to the schedule, weather cancellations, etc.  
 
*Please provide a Mobile/Cell # if you have one.  Information regarding announcements or cancellations may be sent via text.
 
 
Emergency Contact Information (if parent/guardian is unable to be reached)
 
 
Permissions

By checking the medical permission box below and typing my name in the box at the completion of the form below as a parent and/or guardian , I do herewith authorize treatment for my child, named above, by a qualified and licensed medical doctor in the event of a medical emergency which, in the opinion of the attending physician, may endanger his/her life, cause disfigurement, physical impairment or undue discomfort if delayed. 


This authority is granted only after a reasonable effort has been made to reach me.  My signature also serves to indicate my willingness to take full financial responsibility for any and all medical services rendered for the below named participant. My signature also serves to indicate my willingness for my insurance company to be billed for any and all medical fees and services should they be needed and to release Main Street Baptist Church and its employees from this liability.
Please select all that apply.

By checking the photo release box below and typing my name in the box at the completion of the form below as a parent and/or guardian, I understand that as a participant, my children/student may be photographed or videotaped during MSBC sponsored activities and these photos/videos may be used in promotional materials and/or the church website.   I give permission for my child's photos to be used in print/online at the discretion of Main Street Baptist Church. I understand that my child will NOT be named or tagged in any photo.

Please select all that apply.
Electronic Signature
*By entering my name in the box below and submitting this form, I am electronically signing my name on this form.
 
 
 
 

Description

SCUBA VBS August 5-9, 2024
It is important that we receive ONE form submission per child so that we can obtain all important information for that child including any allergies, medications, medical conditions, or other information specific to that child.

After submitting the form, a link will be provided for your convenience to return to the form to register an additional child or children.

Thank you in advance.