Baptist Church | Easton, PA

Child's Name *

First

Last
Grade Entering in September *
Parent/Guardian Name *

First

Last
Parent/Guardian Email Address *
Address, City, State, Zip Code *
Parent/Guardian's Phone Number *
Childs's Allergies/Medical Conditions *
Emergency Contact if Parent/Guardian Cannot Be Reached *

First

Last
Emergency Contact Phone Number *
Individuals allowed to pick up child if Parent or Gaurdian not available *
Permission *

The above named child has my permission to attend the VBS program every day. I also give permission for the above named child's voice and image to be included in photos/videos for promotional purposes. I promise not to hold Bethel Memorial Baptist Church, its staff, the host or sponsoring church responsible for any injuries or sickness that has occurred at or as a result of this program.
Electronic Signature (Parent/Guardian, please type your name and acknowledge that you are signing electronically below) *
Electronic Signature Acknolwedgement *

I understand that by typing my name in the above form it constitutes an electronic signature and I hereby give my permission with that electronic signature. I understand that any pictures of me or my child may be used for electronic or paper promotional purposes
Items to bring

Book bag, Pencil/pen, Notebook, Bible, Water bottle, Beach towel (for water activity on Wednesday), Bathing suit/ change of clothes ( for water activity on Wednesday) (one piece suits for girls)
Things not to bring

Electronics, Alcohol/ tobacco/illegal substances, Jewelry, Knives/weapons of any kind, Money

Items to bring

Things not to bring