Register for VBS

Family Information

By submitting this form I am agreeing to the participation of my child(ren) at VBS. In addition I give permission for any and all medical and/or dental attention to be administered to my child in the event of accident, injury, sickness, etc., under the direction of the bearer of this letter, until I am available. I also authorize the release of any necessary information about my child(ren) in the event of an accident, injury, sickness, etc. I further release from liability Shiloh Baptist Church and any of its ministries or leaders in the event of an accident during the above mentioned event. By filling out this form I also agree to the release of any photos or videos taken of my child during the event on Shiloh Baptist Church's website, print media, or social media page.

Address

Primary Phone

Alternate Phone

Relationship to Student Father Mother Grandfather Grandmother Great-grandfather Great-grandmother Brother Sister Uncle Aunt Guardian Foster Parent Granduncle Grandaunt Other

Phone Number

Adult Bible Study

Would you like more information on attending our Adult Bible Study while your child is participating at VBS?

Student Information

Gender

Birth Date

Age Group

Food Allergies

Details

Medical Concerns

Details

I have more students to register