Vacation Bible School Registration

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Participant's First Name *

Participant's Last Name *

Participant's Preferred Name/Nickname

Participant's Date of Birth *

Participant's Age *

Participant's Last Grade Completed *

Participant's Gender *MaleFemale

Parent/Guardian First Name *

Parent/Guardian Last Name *

Primary Phone # *

Secondary Phone #

Email Address *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Emergency Contact Name (if different from above)

Emergency Contact Phone: *

Authorized PickupPlease list the individuals (other than parents/guardians) authorized to pick up your child:

Does your child have any known allergies? *YesNo

If yes, please list:

Does your child have any medical conditions or special needs we should be aware of? *YesNo

If yes, please explain:

Additional Notes or Special Instructions(Use this space to tell us anything else we should know about your child.)

A. Medical Consent *

I authorize the staff and volunteers of Lewisville Bible Church to seek emergency medical treatment for my child in the event I cannot be reached. I understand that every effort will be made to contact me first.

B. Release of Liability *

I, the undersigned, do hereby release and discharge Lewisville Bible Church, its staff, volunteers, and affiliates from any and all liability for injury, loss, or damage to person or property that may occur during Vacation Bible School.

C. Photo/Video Release *

I give permission for my child’s image, video, and/or voice to be captured and used in internal materials, church presentations, or shared on Lewisville Bible Church’s website, social media platforms, or other promotional materials.

Contact

(972) 436-5648
lewisvillebible1@gmail.com

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Location

Lewisville Bible Church
609 S. Charles Street
Lewisville, TX 75057

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