Memorial Baptist Church
4001 Trimmier Road
Killeen, Texas 76542
(254) 634-6882

Welcome to our
Fellowship

www.membc.org

VBS 2010 CHILD REGISTRATION FORM

– ONE FORM PER CHILD

  • VBS Runs 8:45 am – 12:15 pm, Mon. – Fri., 19-23 July.

  • PRE-REGISTRATION ENDS SUNDAY, JULY 11th

  • KIDS NOT PRE-REGISTERED BY JULY 11th MUST BE REGISTERED IN-PERSON STARTING JULY 19th (Anticipate long lines)

PART 1               AGE LIMIT: Completed Kindergarten – 5th grade
 

VBS is open to children who just completed K5 Kindergarten through 5th grade. Pre-K programs, Head Start, etc. do not qualify as “Kindergarten”.

What grade did your child just complete? 

What is your child’s date of birth? 

Child's Gender:

 

PART 2                CONTACT INFORMATION
 
Child’s First and Last Name:
Child's Street Address:
Child's City and Zip:

Home Phone:  

Parent's E-Mail Address:

Emergency Phone:

   

PART 3              MEDICAL CONDITION
   
Does your child have any medical conditions of concern?

Yes No

If Yes, list medical conditions (including allergies) of concern here:

 
   
PART 4                PARENT VOLUNTEER STATUS
   
Parent's Name:
Are you volunteering at VBS this year?: Yes No
   

PART 5                INDEMNITY AGREEMENT
   

I UNDERSTAND AND HEREBY AGREE TO ASSUME ALL OF THE RISKS WHICH MAY BE ENCOUNTERED DURING ATTENDANCE AT MEMORIAL BAPTIST CHURCH, INCLUDING ACTIVITIES PRELIMINARY AND SUBSEQUENT THERETO, AND SPECIFICALLY INCLUDING OFF-CAMPUS FIELD TRIPS AS WELL AS TRANSPORTATION TO AND FROM MEMORIAL BAPTIST CHURCH AND/OR FIELD TRIPS. I do, for myself and for my child, heirs and assigns, hereby irrevocably and unconditionally release, acquit and forever discharge Memorial Baptist Church and its agents, employees, drivers, and volunteers from any and all liability, actions, causes of actions, claims, expenses, obligations and damages of any nature whatsoever, which I now have or which may arise in the future, in connection with my child’s participation at Memorial Baptist Church or any other associated activities including but not limited to, any injury to my child or property, even injury resulting in death. I expressly agree that this release, waiver, and indemnity agreement is intended to be broad and inclusive as permitted by the law of the State of Texas and that if any portion hereof is held to be invalid, it is agreed that the balance shall, not withstanding, continue in full legal force and effect. This release contains the entire agreement between the parties hereto.
 

By submitting this form, I agree to the terms of the above indemnity agreement.
 

Vacation Bible School Child Registration Form

 If you have any question please e-mail Bob Maindelle

 

If you are having trouble with this form, you can save and print out a copy here.