Register for Into the Wild VBS | June 10-14 | 6 to 8 P.M.

Child's Name *
Child's Name
Date of Birth: *
Date of Birth:
Address *
Parent/Guardian's Name *
Parent/Guardian's Name
Parent Phone: *
Parent Phone:
Emergency Contact: *
Emergency Contact:
Emergency Contact Phone: *
Emergency Contact Phone:
Agreement: *
By participating in Vacation Bible School at Grand View Baptist Church, I understand the potential for accident or injury and do hereby release Grand View Baptist Church, its staff and volunteers from any responsibility associated with potential injury incurred as a participant. I authorize Grand View Baptist Church representatives to obtain any emergency medical treatment needed on my behalf. I waive and discharge Grand View Baptist Church, its members and volunteers from and all claims or liability of any kind or nature arising from participation of myself, my dependents, and those in my care during this event. I further grant permission for officials of the event to use our likenesses whether photo or video for media reporting or promotional purposes.