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 3rd-7th 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.

Physical Release/Liability Form *

I understand that I must complete, sign, and date the physical waiver/release form and return it to the church on or before the morning of VBS.

I understand that I must complete, sign, and date the physical waiver/release form and return it to the church on or before the morning of VBS.

I understand that if the physical waiver/release form has not been returned to the church that my child/children will not be allowed to participate at Vacation Bible School.

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