EHBC Vacation Bible School
Registration Form
PLEASE FILL OUT A SEPARATE REGISTRATION FOR EACH CHILD
Today's Date
Child's Name
Address
City / State / Zip
Home E-mail Address
DOB & Grade for the 2008-09 school year
Emergency Contact Name / Phone #
Allergies / Medical Conditions
Home Phone / Cell Phone
Medical Release
By checking this box I, the undersigned parent or guardian, grant permission for the
above-named child to attend Vacation bible School.  In the event of an emergency
where medical treatment is required, I give permission to the church staff to obtain
the services of a licensed physician.  I understand that I or the emergency contact
person will be notified immediately concerning any such emergency.  I hereby
release and discharge the adult leaders, event staff and East Hampton Baptist
Church from any and all debts, judgements or suits of any kind that may arise by my
child's participation in this event.  Payment of any medical expenses will be paid by
me or by my insurance company.
Parent or Guardian Name / Date
Relationship to Child
Permission to use Child's Photograph
I the undersigned parent or guardian, grant permission to East Hampton Baptist
Church of Hampton, VA to use picture's of the above-named child on the web site of
East Hampton Baptist Church.
YES
NO
Parent or Guardian Name / Date
Relationship to Child