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Child's Name

First Name

Last Name

Gender

Male

Female

Grade Entering in Fall 2025

Address

City

State

Zip

Parent/Guardian

Who may pick up your child at the end of the day?

Home Phone

Work Phone

Cell Phone

Email Address

Emergency Contact

Relationship to Child

Phone

Name of Home Church

Food Allergies

yes

List Food Allergies

Medical Concerns

yes

Explain Medical Concerns

I hereby grant permission to Calvary Baptist Church, Brewer, Maine to record sounds, images or video of my child, listed above, while attending VBS. I also give permission for Calvary Baptist Church, at its sole discretion, to use these sounds, images, videos in publications (including print, websites, and social media platforms) managed by Calvary Baptist Church in relation to Vacation Bible School. Entering my name below constitutes a signature and grants this permission. PARENT/GUARDIAN NAME:

Date

YYYY

207 989-3912

61 State St.

Brewer, ME 04412

VBS Registration

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Calvary Baptist Church