| *First Name: |
__________________________________ |
| *Last Name: |
__________________________________ |
| *Address: |
__________________________________ |
| *City: |
__________________________________ |
| *State: |
__________________________________ |
| *Zip: |
__________________________________ |
| *Cell Phone or Preferred Phone: |
(______)______-________ |
| Home Phone: |
(______)______-________ |
| Email: |
__________________________________ |
| *Gender: |
Male Female (circle one) |
| *Age: |
__________________________________ |
| Completed 6th Grade Only Sponsors Name: |
__________________________________ |
| YOUTH ONLY: Please contact me by: |
__________________________________ |
| YOUTH ONLY: Parent Cell: |
(______)______-________ |
| YOUTH ONLY: Parent Email: |
__________________________________ |
| YOUTH ONLY: I am participating with: |
__________________________________ |
| *I would like to help in VBS as a: |
__________________________________ |
| *Would you like to teach your child?: |
Yes
No
N/A (circle one) |
| I would like to teach my child named: |
__________________________________ |
| *I am a first time VBS teacher at FBC Allen: |
YES
NO (circle one) |
| *I have committed my life to Jesus as Savior & Lord: |
YES
NO (circle one) |
| *Church Membership: |
First Baptist Church
Member of another church
Not a member of a church (circle one) |
| If church member elsewhere- where?: |
__________________________________ |
| I hereby grant, voluntarily and with full understanding, to First Baptist Church Allen, a license to the following: Use and storage of my name and image, by means of digital or film photography, video photography, audio recording or other documentation, including printed or electronic publications, and website created by or for FBC Allen for its sole benefit with respect to the activity, namely Vacation Bible School. If I am signing this agreement on behalf of a minor child I hereby warrant that I am the legal parent or guardian of the child and that I have the legal authority to sign this agreement on behalf of the child. If a dispute over this agreement or any claim for damages arises, I agree to resolve this matter through a mutually acceptable alternative dispute resolution process. If I cannot agree with FBC Allen upon such a process, the dispute will be submitted to a three-member arbitration panel of the American Arbitration Association for final resolution. |
| *I give my consent to the above statement: |
YES
NO (circle one) |
| Comments: |
|
| *Do you have preschoolers or children to register?: |
YES
NO (circle one) |
