VBS Registration 2021

Open to all children in preschool and those entering grades 1-6. Free of charge!

Dates: Monday - Friday, June 14 - 18, 2021
Times: 6:00 - 8:30 p.m.
Location: Cedar Creek Baptist Church, 7709 Bardstown Road

Please fill out a registration form for each child participating.

Child Information

Child Name

Child is entering...

Child's Date of Birth

Parent/Guardian Information

Parent/Guardian Name

Parent Address

Parent Email

This address will receive a confirmation email

Parent/Guardian Cell

Where do you attend church?

Emergency Contact Information

Emergency Contact Name

Emergency Contact Number

Medical Information

Does your child have any allergies?

Does your child have any condition or illness that would prevent their full participation in any physical activity?

Yes No

If yes, please explain in detail here.

Is your child dependent on an albuterol or rescue inhaler?

Yes No

Does your child have any of the following conditions?

Asthma Heart Murmurs Epilepsy Kidney Problems Chronic Back Pain None

Release & Waiver

I give consent for my student to participate in the “Vacation Bible School” with Cedar Creek Baptist Church (CCBC). I do not hold CCBC, volunteers, associates, or any of her subsidiaries liable for any injuries, accidents, or illnesses incurred during the event. I understand I am responsible for the expenses of my child's medical care and that my family insurance is primary.

I understand that I am responsible for my child’s transportation to and from the location of the event.

I also give my permission for my student’s photo to be used in CCBC flyers, its website, or advertisements produced by CCBC.

I have read the release and give my child permission to participate in VBS.

Yes

Electronic Signature

Date

VBS Registration 2021

Description

Please Fix the Following