VBS 2024 Registration — First Baptist Church, Corbin Kentucky

VBS 2024 Sign-uP: “Deep sea”

Monday, July 15th- Thursday, July 18th

We’re excited you will be joining us for VBS! Please help us save a spot for your child by filling out the following

(If signing up to volunteer- please insert your information below to sign-up).

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Student's Name

If signing up as a volunteer, insert your own name & info.

First Name

Last Name

Birthday

YYYY

Grade (What grade your student just completed)

If signing up as a volunteer, select "Volunteer".

T-Shirt Size

Parent/Guardian 1

Parent/Guardian- First & Last Name (Volunteers- type "Self" and insert your own contact information, medical info, allergies, etc.)

Parent/Guardian 2

Parent/Guardian 1- Phone

(###)

###

####

Parent/Guardian 2- Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Medical Stuff

Does your Student have hospitalization insurance?

Yes

If yes, please list the name of your insurance provider and policy number:

Medications/Allergies

We will be serving dinner! Please list any medications your child is taking or any food/drug allergies:

We like to capture memories

Do you give FBC of Corbin permission for your student’s picture/video to be taken and displayed?

Yes

Student Needs

Any conditions/restrictions you would like us to be aware of for your child (i.e. asthma/rescue inhalers, limitations on physical play, accessibility & sensory needs, etc.)?

General/Vehicle Permission & In Case of Emergency

By clicking SUBMIT you are agreeing to the following: General/Vehicle Permission- I, the parent/guardian(s) listed above, give permission for my student to attend the above mentioned FBC of Corbin activity and ride in any vehicle designated by the adult in whose care the minor has been entrusted while participating in these activities. In Case of Emergency- I, the parent/guardian(s) listed above, authorize the adult, in whose care the minor has been entrusted, to consent to any x-ray, anesthetic, medical, surgical, or dental diagnosis, treatment, and/or hospital care, to be rendered under the general or special supervision and on the advice of any medical professional licensed under the Medical Practice Act whether such diagnosis or treatment is rendered at the office of said professional or at said hospital. I agree to be liable/pay all costs associated with any necessary treatment.