Parent/Guardian Name *

First Name

Last Name

Parent/Guardian Phone *

(###)

###

####

Child's Name *

First Name

Last Name

Child's Gender *

Choose One

Male

Female

Consent *

By checking this box, I agree to the following: 1. That I attest that I am 18 years or older. 2. That I attest that I am the parent or legal guardian of the child being registered. 3. In order to meet legal requirements, I hereby authorize a representative of South Valley Baptist Church to give consent for any and all necessary care for my child, while said child is in South Valley Baptist Church's custody. 4. I give permission for the aforementioned child to attend South Valley Baptist Church VBS from June 17-21, 2024. 5. I will not hold the church staff or volunteers responsible in case of sickness or accident. 6. I assume all responsibilities and risk of injury associated with VBS activities.

Accept