Vacation Bible School Emmanuel Baptist Church

Pre-K 6th Grade

(completed)

July 15th 19th Monday Friday

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For God has not given us a spirit of fearfulness, but one of power, love, and sound judgment. 2 Timothy 1:7

9:00 am 12:00 pm 9:00 am 12:00 pm

Bible Stories Games Prizes Crafts Music Food

* Free Snack provided everyday *
* Transportation will be available everyday to and from the church
(If transportation is needed, make note of this on your registration form)

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For more information call Jesse Motley: 580-482-1775 or Email: ebcjesse@sbcglobal.net
Please return Registration Form and Medical Release form to:

Emmanuel Baptist Church 800 North Forrest St. Altus, OK 73521

Registration Form
Childs Name Parent/Guardian Name Address
(street address, city, state, and zip code)

Mailing Address (if different) Phone Numbers Home Work Cell Email Age Information Birth date Last grade completed in school Medical Information Medical or other information we need to know. (Please include any food allergies.)

Emergency Contacts (Other than listed above.) Name Name Phone number_ Phone number_ Yes No

Does your child need transportation?

Dismissal Information Who may pick up your child at the end of each VBS day?

Other Information Does your child attend Sunday School? If so where?

If your child is visiting our church, who is he/she a guest of?

May we have permission to photograph your child?

Yes

No

May we have permission to use your childs photograph for the purpose of promotion? Yes No
Administrative Guide CD, Registration Form 2012, LifeWay Christian Resources of the Southern Baptist Convention VBS 2013 Published in the United States of America OK to Copy

Emmanuel Baptist Church 800 North Forrest Altus, OK 73521 (580)-482-1775

Emmanuel Baptist Church

Pastor: Boyd Whitehead

PARENTAL CONSENT AND MEDICAL AUTHORIZATION: FIELD TRIPS

I, ____________________________________________, the parent or legal guardian of ______________________________________________ do give consent to the participation of the child named above for the year of 2013. I give consent for my child, listed above, to take part in any or all the activities, including but not limited to physical or athletic activities for the youth or children at Emmanuel Baptist Church, Altus, Oklahoma, including field trips.

______________________________________ Signature of Parent/Guardian ______________________________________ Address MEDICAL TREATMENT AUTHORIZATION

_________________ Date _________________ Phone Number

I understand that I will be notified in the case of a medical emergency involving my child listed above. However, in the event that I cannot be reached, I authorize the calling of a doctor and the providing of necessary medical services in the event my child, listed above, is injured or becomes ill. I understand that Emmanuel Baptist Church will not be responsible as parent/guardian.
I agree to notify the church in the event of any health changes which would restrict my childs participation in any normal youth activities. I also understand that the adult supervisors reserve the right to restrict my child from any activity that they feel is not within the physical capabilities of my child.

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Insurance Company

___________________________
Insurance Company ID/Medicaid Number

___________________________
Signature of Parent/Guardian

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Date