2013 VBS SIGN UP SHEET!!
To sign up for our free VBS please copy & paste the document below into Word or Pages, print it, fill it out, and return it to the church office.
Church Office hours Mon-Fri 10-5pm
July 8th - 12th 4yrs - 6th grade 9am - 12:00pm
July 8th - 12th 4yrs - 6th grade 9am - 12:00pm
FREE
First Baptist Church of Monterey 600 Hawthorne Street, Monterey, CA 93940 Phone: (831) 373-3289 VBS Registration : 7/8 - 7/12 : 9am - 12:00pm : 4yrs - 6th grade
Name of Child: _________________________________________ M/F Birth Date:_____/_____/_____ Grade Child Will Be in Fall of 2013: _________ (4 years - 6th grade) Address: ________________________________________ City: ________________ Zip: ____________
Phone: ________________________ Secondary Phone: ________________________
Emergency Contact (name): _____________________________ Relationship to Child: ______________ Phone: _________________________ Secondary Phone (cell/work): __________________________ Health History: ___ Allergies ___Asthma ___Diabetes ___
Heart Condition ___ Epilepsy/Nervous System ___ Other If you have checked any of the above please explain: _________________________________________ ____________________________________________________________________________________
____________________________________________________________________________________ Date of last tetanus shot: _________ Activity Restrictions: ______________________________________
This health history is correct, so far as I know. I hereby give my permission to the licensed physician, nurse or medical care provider designated by the group leader to secure medical aid as required for illness or injury under a physician’s orders, including transportation to and from the
necessary facilities. I understand that I will be billed for any professional services rendered.
I desire for my child to participate in VBS, 2013 at First Baptist Church of Monterey. In consideration of First Baptist Church providing this activity, I do hereby release First Baptist Church, its officers, its employees, agents and members of its Board from all claims and causes of action by
reason of an injury, which may be sustained as a result of this church activity.
The above information is true and I give my consent as parent and/or guardian for my child,_________________________________ to participate in First Baptist Church of Monterey’s VBS, 2013.
Signature:___________________________________________ Date: ____/____/____
Print Name: __________________________________________
Office Use Only: ______________________________________________________________________ ______________________________________________________________________
______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________
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