VBS 2023 Child Participant Form

June 25 (4 PM - 7 PM) and June 26-29 (9 AM - 12 Noon) | Join us for VBS 2023 as we discover how Jesus guides us through the twists and turns of life through a fantastical celebration of games!

Child's Name

Gender

Please select one option.

Male Female

Birthdate

Last Grade Completed (maximum class size 30 students)

Please select one option.

4 Year Old Class Pre-Kindergarten Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade

Allergies, Medical, and Special Needs: (Leave blank if none)

Do you give FBC Mooresville permission to use your child's photograph for print publications, online publications, presentations, websites, and/or social media?

Photo Release

Please select one option.

Yes No

Parent / Guardian Name

Address

Cell Phone

Do we have permission to text you with changes / updates about VBS?

VBS Update Permission

Please select one option.

Yes No

Alternate Phone

This address will receive a confirmation email

Does your family attend church?

Church Attendance

Please select one option.

Yes No

If so, where? (Optional)

Medical Consent: I authorize and appoint FBC Mooresville and its staff to act as a medical agent on my behalf. As agent, FBC Mooresville may give consent to medical treatment and examination, if they are unable to contact me.

Medical Consent

Please select one option.

Yes No

Emergency Contact Name

Emergency Contact Phone

Authorized Pickup Name #1

Authorized Pickup Name #2

Description

June 25 (4 PM - 7 PM) and June 26-29 (9 AM - 12 Noon)

Join us for VBS 2023 as we discover how Jesus guides us through the twists and turns of life through a fantastical celebration of games!

VBS 2023 Child Participant Form

Description

Please Fix the Following