"One Way" Vacation Bible School (VBS) is a free program from Fort Lauderdale Baptist Church. Children will have games, skits and contests, and will be challenged to memorize verses and listen to a lesson from the Bible. Snacks, prizes, and all activities are included free of charge. For a child to attend, their parent or legal guardian needs to submit this form.

Basics

Parent/Guardian Full Name:
Address:
Apt. #:
City:
Zip:
Phone Number:
Email:

Emergency Contact

Name:
Number:

Children (Ages 6-12)

Child 1

First Name:
Last Name:
Age:
Birthday:
Allergy/Condition:

Child 2

First Name:
Last Name:
Age:
Birthday:
Allergy/Condition:

Child 3

First Name:
Last Name:
Age:
Birthday:
Allergy/Condition:

Child 4

First Name:
Last Name:
Age:
Birthday:
Allergy/Condition:

Insurance

Insurance Information to be used only in the event of an emergency and in conjunction with contacting you.

Insurance Company:
Policy #:
Group#:

Consent

I give consent for photographs/videos of the children above taken during this program to be used for promotional purposes of Fort Lauderdale Baptist Church and affilliate churches.

I hereby give permission for all the children listed above to ride the bus/van, participate in all activities, attend VBS, and attend Fort Lauderdale Baptist Church. I understand that the children listed above will be under adult supervision at all times. I further understand that in signing this, I release and hold harmless Fort Lauderdale Baptist Church, its pastor, directors, officers, employees, and any volunteers from any liability, past or future, fully and completely. I authorize the executive staff or designated medical professionals to administer emergency medical assistance in the event that I cannot be reached.

By entering your name and date here you consent to all the above.

Parent/Guardian Signature:
Date: