Westwood Baptist Church 2019 VBS

MISSION POSSIBLE

VACATION BIBLE SCHOOL REGISTRATION
Liability Release
By submitting this form, I hereby agree that Westwood Baptist Church (WBC) is not responsible for any accidents that may occur in or on property of Westwood Baptist Church.

I hereby agree that I will not file a lawsuit against WBC or any of its volunteers or employees in the event of accident, injury or death.

Question Title

* 1. Name (First and Last)

Question Title

* 2. Address (Street, city, state and zip code)

Question Title

* 3. Phone number (XXX-XXX-XXXX)

Question Title

* 4. Age

3-5

6-8

9-12

13-17

18-34

35+

Question Title

* 5. Gender

Male

Female

Question Title

* 6. Emergency contact information (Name, Phone number, Relationship)

Question Title

* 7. Do you need transportation to VBS?

Yes

Question Title

* 8. Do you have any allergies? (Ex. Food or environmental)

Question Title

* 9. Do you have any dietary restrictions or limitations?

Yes

Question Title

* 10. Do we have your permission to take pictures of you which maybe used in print or electronic communications including website and email?

Yes