VBS Registration Form

PLEASE NOTE: When filling out the Grade for your child, please put the CURRENT Grade they are in.

Your name *

Email address *

Phone number *

Address *

Household members

Please add all children that will be attending VBS.

If your child has allergies or special needs, please list them in the Medical Notes section. If none, please put N/A.

Nursery-Aged Child

If you need to add a child that will be in the Nursery, please fill in the Child's Name, Gender, Birthday, and Allergies.

For example, (Joe Smith / Male / January 1, 2024 / Milk Allergy)

For more than one Nursery-Aged Child, please separate children by parentheses.

Emergency Contact Name *

Emergency Contact Number *

Emergency Contact Relationship *

Trusted People Allowed to Pickup Child *

Please provide: Name, Phone Number, and Relationship to child for EACH person.
This is in case we need to reach out to that person during service times.

For example, (Joe Smith / 999-999-9999 / Grandfather)

If does not apply, please type N/A.

Untrusted People Not Allowed to Pickup Child *

If does not apply, please type N/A.

I, the parent or guardian, have read and hereby agree with the following waivers, conditions and policies listed below: *

1) I assume all risk and responsiblity for personal injury, sickness, damage and expense whatsover as a result of my child(ren) attending and participating in Poplar Springs North Ministry activity and hereby release and discharge Poplar Springs North Baptist Church, Inc., its directors, corporation members, staff and volunteers from any liability arising thereby.

2) I authorize an adult in whose care my child(ren) has been entrusted, to seek on my behalf any emergency medical treatment deemed necessary by them for whatever reason should, in their discretion, the need arise. In such a situation attempts will be made to notify the parents/guardians as soon as possible. I agree to be fully financially responsible for any such medical treatment or emergency services and agree to reimburse Poplar Springs North Baptist Church for any costs they may incur as a result.

3) I give permission for my child to ride in any vehicle designated by the adult in whose care my child(ren) has been entrusted while participating in a Poplar Springs North Children's Ministry activity.

4) I give permission for photographs, digital images, video, and/or audio recordings to be taken of my child(ren) which may be used on the Poplar Springs North website, in print, and other media for the purpose of promotion, illustration, advertising or publication, without compensation. All recorded media; prints and created media from the content shall constitute the property of Poplar Springs North and will not be sold.

5) The parent(s)/guardians(s) submitting this application are those having legal custody over the child(ren). Conditions of custody, if applicable, will be fully communicated in writing to Poplar Springs North Baptist Church, Children's Ministry.

Parent/Guardian Signature *

Please type your name in the box below. In doing so, digitally respresents a signature as if physically written.

Would you like materials sent to you for your child to learn more about God?

The Mailbox Club is a wonderful way to get your children more involved with the Bible!