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Registracion del Participante

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First Baptist Church Roanoke

Location

321 Marshall Avenue

Roanoke, VA 24016

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Contact Anne Edwards:

540-224-3300

aedwards@firstroanoke.com

Primero, cuéntenos sobre usted:

Información de los Padres

Please note that the Parent or Guardian's information is first!

Nombre

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Apellido

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Correo Electrónico

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Preferred Phone Number

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Dirección 1

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Ciudad

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Estado/Provincia

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ZIP/Código Postal

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Nombre del Contacto de Emergencia

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Teléfono del Contacto de Emergencia

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Additional Emergency Contact Name & Phone

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Besides the emergency contacts already listed, please list any other people who may pick up your child from VBS.

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Home church affiliation (if any)

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How did you find out about VBS?

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Cuéntanos sobre tu participante

Nombre

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Apellido

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Name child goes by (for name tag)

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Género

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Fecha de nacimiento

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Grado Actual

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Please note:

"Current Grade" indicates the grade completed by the start of VBS in June
Nursery is childcare for VBS workers ONLY (Infant to age 3)
Preschoolers may attend VBS if they are age 3 by January 1, 2025 and are fully potty trained.

What school does the child go to?

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Alergias

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Preocupaciones Médicas

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If you are not a church member, what child invited you? (Name & Grade Level) **Church members, please skip!

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If your child is part of a Daycare or Camp group coming to VBS, please note it below:

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Special Requests

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My son/daughter has my permission to participate in Vacation Bible School on June 16-20, 2025. I do release First Baptist Church Roanoke, their ministry and volunteer leadership from liability for injury or accident, and do give my permission to the church’s leadership to administer basic first aid and secure proper medical attention should the need arise. I also understand that publicity photographs and videos may be taken during VBS and by registering for VBS at First Roanoke, I hereby give permission that photos/videos containing my child's image may be used in publication. If I do not agree with this statement, I will email aedwards@firstroanoke.com to have my child not photographed individually, but also acknowledge that large group photos may still be taken. Lastly, I understand that serious behavior or discipline problems may result in my being called to come and get my child.

Please initial that you agree to the above statement and email aedwards@firstroanoke.com with any media concerns.

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