First Baptist Church Matthews, NC

Enrollment Form for Vacation Bible School 2010

Instructions for this form:  Please complete the family information at the top of the form as it pertains to the child you are registering.  If you have insurance for your child(ren) please be prepared to give policy information on this form before submitting.  At the bottom of this form you will be required to sign a medical release and a liability release.  Please read over those statements carefully before submitting this form.  When you submit this form you will be able to return to this page to register additional children.

Family Information:

Parent's Name:
Address:  

City:   State:    ZipCode:

Home Phone:   Work Phone:   Cell Phone:

Email: 

Do you attend church or Sunday school? yesno  If yes, where?

Please complete the following information for each child you are registering.  When you have completed the information for your child(ren), please scroll to the bottom and carefully read the release information and sign the form and submit. You can return to this page to register additional children.

Child's Name:  Gender:MaleFemale
Birthdate:   Last Grade Completed:  123456(ages listed correspond with availability of classes left)

Campers who are in grades 3-6 can select a breakout group that they will participate in each day.  From the list below please fill in your top three, in the order of preference 1 or 2, with 1 being your favorite.  We will do our best to place your child in the group that they prefer. 

Breakout Group Choices for Children 3-6 grade:

Camping skills:

Crafts:

Is there any Medical or special information we need to know about your child? (if none please indicate "none"):

Do you have health insurance for this child? yesno 
If yes, please complete the following:
Name of Carrier: Policy #:
(Please bear in mind that the church's insurance is only secondary insurance.  If you have medical insurance, your carrier will be billed for any medical charges  in the case of illness or injury while your child is on a church-related activity.)

Please read the following sections carefully and feel free to call Cheryl Markland at the church office or send her an email if you have any questions or concerns.

Emergency Contact Person other than parent above:
Name:     Phone Number:

Physician Name:   Physician Phone Number:

All children must be picked up at their classroom door by an authorized adult.  Please list the adults who are authorized to pick up your children in the event you are unable to do so:

Medical Release:

Liability Release: By submitting your electronic signature in the box below and clicking the submit form button, you, the parent or guardian, agree to assume and accept all risks and hazards inherent in church-related social activities.  You also agree not to hold this church, First Baptist Church of Matthews or its employees or volunteer assistants liable for damages, losses, or injuries to the person or property undersigned.  The parents or guardians understand that they are signing for the minor(s) listed above on this form and the signature is both a medical and liabilty release.

Signature: