Victory Lap VBS

Child's Name

Birthdate

Age Group

Gender male female

Address

Allergies

Parent's First Name

Parent's Last Name

Phone

This address will receive a confirmation email

Emergency Contact

Phone Number

I, the undersigned parent/guardian, give permission for my child above mentioned child to participate in Electric City Baptist Church's Vacation Bible School.

I understand that there are inherent risks associated with participation in VBS activities and I release and hold harmless Electric City Baptist Church, its staff, volunteers, and affiliates from any and all liability for any injury, loss, or damage to person or property that may occur during VBS.

In the event of an emergency, I authorize Electric City Baptist Church to obtain necessary medical treatment for my child, including first aid, medication, and transportation to a hospital.

I understand that every effort will be made to contact me prior to obtaining medical treatment, but I authorize Electric City Baptist Church to proceed if contact is not possible.

I have read and understand all the information provided on this form

agree

Electronic Signature

Description

July 30-Aug 1 6pm-8pm

Ages 5-11
Registration starts at 5:40 pm
2350 Hamburg st. Schenectady NY 12303
Please fill out this form and click submit.