Northlake Baptist Church Vacation Bible School

Northlake Baptist Church
4823 Thompson Bridge Rd
Gainesville, GA 30506
Ph: (770) 536-7338
[email protected]
Fax to Northlake Baptist Church
770-536-1230
NorthlakeBaptistChurchVacationBibleSchoolRegistration
Student’sName:
Age: LastGradeCompleted:
Birthdate:
Parent’s/Guardian’sName:
Address:
CellPhone:
Email: HomePhone: EmergencyContact:
Name: PhoneNumber:
Relationship:
Pleaselistanymedicalconditionsforwhichyourchildisbeingtreated,includingallergies,
especiallytofoodorinsects.
Willyourchildhaveanepipen,inhaler,orothermedicationduringVBS?YESNO
Ifyes,pleaselist.
DoesyourchildattendSundaySchool?Ifyes,where?
HowdidyouhearaboutVBSatNorthlake? Who,besidesyou,maypickupyourchildfromVBSeachnight?
Maywehavepermissiontophotographyourchild?YESNO
____IunderstandthatifmychildisenrolledinapreschoolclassatVBSthatImustremainon
campus.
____IreleaseNorthlakeBaptistChurchandVacationBibleSchoolworkersfromanyliability
shouldmychildbeinjuredduringVBSandauthorizearepresentativeofNBCtoseek
appropriatemedicalcareformychildinmyabsence.
ParentSignature:_______________________________________________Date_______________