Parent/Legal Guardian *

First Name

Last Name

Parent/Legal Guardian Phone Number *

(###)

###

####

Birthdate *

MM

DD

YYYY

Emergency Contact Phone Number *

(###)

###

####

Rules of Dismissal *

I will pick my child/children up at 11:00 am in the sanctuary

I have read and agree to the Rules of Dismissal.

Dates *

June 2nd-6th 8:30 to 11:00am

I have read and agree to the program's dates.

Rules of Respect *

My child will respect teachers, leaders, and volunteers. My child will follow directions, behave appropriately in class and on the playground. My child will respect other students. He/she will keep hands to self, will not call other children names, and will not bully other students. All of my child's electronics, games, cards, and toys need to be left at home. If they are not they will be taken up and taken to the office where the parent/guardian will need to pick them up. If my child has a cell phone out during VBS it will be taken up and returned at the end of the day, cell phones should be left in my child's pockets. Your child must agree to report to the teachers and leaders if they observe another student not following the rules of respect.

I have discussed these terms with my child and we agree to abide by the Rules of Respect.

Disciplinary Actions *

a) first offense of the day – time out – with an adult volunteer b) second offense of the day call parent for pick up *If the first offense is a physical altercation between students, parents can be contacted for pick up immediately

I have discussed these disciplinary actions with my child and we agree to abide by them.

Permission and Liability Release *

I understand that by clicking this box, I am stating that I am the parent/guardian of the child listed on this form, and I am giving permission for my child to attend Vacation Bible School at First Baptist Church Valley Mills on June 2nd-6th, 2025. By clicking this box, I am also stating that I uderstand that there are potential risks in this event and do not hold First Baptist Church Valley Mills or its leaders/volunteers responsible or liable for any accidents.

By checking this box, I am stating that I am the parent/guardian of the child listed on this form, and I am agreeing that in the event that my child sustains an injury while attending Vacation Bible School , I give my permission to whoever is in charge to take whatever steps necessary to stop any bleeding and to administer first aid as needed. I also consent to an X-ray examination, anesthetic, medical (or dental) or surgical diagnosis and treatment and hospital care, and the administration of drugs or medicine to be rendered to my child under the general or specialized supervisor and upon the advice of a duly licensed physician and/or surgeon.

Photo/Video Use Permission *

First Baptist Church Valley Mills has my permission to take photos and videos of my child(ren) and post them on fbcvm.org and social media platforms (Facebook, Instagram, etc) for promotional purposes.

I agree that First Baptist Church Valley Mills has my permission to take photos and videos of my child(ren) and post them on fbcvm.org and social media platforms (Facebook, Instagram, etc) for promotional purposes.

I Am the Parent/Guardian of the Child Listed On This Form

I agree