| *Home Church Affiliation: |
I am a member of Bay Leaf Baptist Church.
I am a member of another church.
I currently do not have a church home. (circle one) |
| If you attend church elsewhere, which church do you attend?: |
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| PARENT INFORMATION |
| *Parent/Guardian Name: |
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| *Cell Phone: |
(______)______-________ |
| *Email: |
__________________________________ |
| *Address: |
__________________________________ |
| *City: |
__________________________________ |
| *State: |
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| *Zip: |
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| *Emergency Contact Name (1): |
__________________________________ |
| *Emergency Contact Phone (1): |
(______)______-________ |
| *Emergency Contact Relationship 1: |
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| Emergency Contact Name (2): |
__________________________________ |
| Emergency Contact Phone (2): |
(______)______-________ |
| *Emergency Contact Relationship 2: |
__________________________________ |
| CHILD INFORMATION |
| PLEASE NOTE: Your child's medical release has been included as part of this registration form. By clicking "Register Participant," you are signing your child's registration form and medical release form. |
| As a reminder, please select the grade below that your child is leaving/has completed this past 2024-2025 school year. WE ARE NOT ACCEPTING RISING KINDERGARTNERS THIS YEAR. We look forward to them joining us summer 2026! |
| Also as a reminder, preschool ages for VBS (nursery, ones, twos, threes, fours, fives) is only available for children whose parents are volunteering. PLEASE DO NOT SIGN UP YOUR PRESCHOOL CHILD FOR VBS IF YOU ARE NOT A VOLUNTEER. Thank you! |
| *Grade Leaving: |
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| Note: If this registration is a preschool registration for a volunteer child, please select your child's current age:: |
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| *Participant's First Name: |
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| *Participant's Last Name: |
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| *Preferred Name for Name Tag: |
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| *Birthday: |
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| Gender: |
Male Female (circle one) |
| Friend Request: |
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| Our church uses photos and videos of our guests for communication purposes. These photos and videos may be used in highlighting Vacation Bible School (VBS) through video as well as promoting VBS, either in print or on the internet. Signing this release grants us permission to use your and your child's image for these purposes. |
| *Photo Release Signature: |
Yes
No (circle one) |
| MEDICAL AND RELEASE FORM |
| I fully realize that any activity involves a risk of personal injury, property, damage, or loss of my person or property. I hereby for myself, my heirs, executors, and administrators, waive and release any claims or rights against Bay Leaf Baptist Church, all of it officers, directors, and coordinators, all owners of equipment which may be used and those who volunteered their equipment, vehicles, and services for any church activity, for any and all injury, damage, or loss to my person or property incurred during a church sponsored activity. |
| It is my understanding that Bay Leaf Baptist Church will attempt to notify me in case of a medical emergency involving my child. If Bay Leaf Baptist Church staff members, chaperones, or any other Bay Leaf leader cannot reach me, then I authorize Bay Leaf Baptist Church to secure any medical treatment necessary for my child by any licensed physician or dentist, including the admission for such emergency care to any hospital reasonably accessible. This authorization does not include major surgery unless two licensed physicians or dentists concur that immediate surgery is necessary. I give my permission to the doctor or other health-care professional to provide the medical services he or she may deem necessary. I will accept responsibility for medical expenses so incurred. |
| *Insurance Carrier: |
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| *Member Number: |
__________________________________ |
| *Group Number: |
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| Allergies, Medical, & Special Needs: |
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| Any Current Prescription Medications incl. EpiPin?: |
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| Comments: |
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