2026 VBS Registration

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Parent/Guardian/Adult's Name *

Parent/Guardian/Adult's Email *

Parent/Guardian/Adult's Phone *

How many total people from your household will participate in In-Person VBS? *

Participant #1 *

First

Last

Age Group of Participant #1 *

5 years old and under
6-8 years old
9-12 years old
13-17 years old
18 years and older

Participant #2

First

Last

Age Group of Participant #2

5 years old and under
6-8 years old
9-12 years old
13-17 years old
18 years and older

Participant #3

First

Last

Age Group of Participant #3

5 years old and under
6-8 years old
9-12 years old
13-17 years old
18 years and older

Participant #4

First

Last

Age Group of Participant #4

5 years old and under
6-8 years old
9-12 years old
13-17 years old
18 years and older

Participant #5

First

Last

Age Group of Participant #5

5 years old and under
6-8 years old
9-12 years old
13-17 years old
18 years and older

Participant #6

First

Last

Age Group of Participant #6

5 years old and under
6-8 years old
9-12 years old
13-17 years old
18 years and older

Medical Concerns, Food Allergies, Etc. For All Attendees (Explanation is listed below) *

If any participants have food allergies or medical concerns, please list ALL NAMES, along with the food allergies and medical concerns in this box. (list such items as bee stings, other severe allergies, hemophilia, diabetes, and heart disease, etc). If you have no allergies or concerns please put "N/A" in the box.

Do we have your permission to photograph your child? *

Yes
No
Not Applicable

Do we have your permission use your child's photograph for the purpose of VBS promotion? *

Yes
No
Not Applicable

Medical Release Authorization (Description Below) *

In the event of an accident or illness, I understand that reasonable efforts will be made to contact the parent/guardian immediately. However, if I am not available, I authorize representative of FBC-Chapel Hill to secure emergency medical care as needed.

Name and Number of Doctor *

Name of Insurance Carrier *

The parent/guardian/participant signing this form understands and agrees that First Baptist Church of Chapel Hill, the operator of this Vacation Bible School Program, is not liable for injuries or losses except those resulting from violations of the state laws or gross negligence which may result from participation in this program. I hereby give consent for all participants listed on this form to participate and authorize First Baptist Church to seek medical release in the event it is needed, and not hold the church responsible for any liability. I, therefore, authorized everyone listed on this form to participate in the First Baptist Church VBS, August 5-7, 2026

(Electronic Signature): Please type your first and last name and date

FBC Live/Videos On-Demand

Address

106 North Roberson Street
Chapel Hill, NC 27516
Phone: (919) 942-2552
Fax: (919) 942-2586

Website: http://ourfbc.org
Email: info@ourfbc.org

Disclaimer

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