Register for VBS

Family Information

Address

Primary Phone

Relationship to Student Father Mother Grandfather Grandmother Great-grandfather Great-grandmother Brother Sister Uncle Aunt Guardian Foster Parent Granduncle Grandaunt Other

Phone Number

I agree to release and discharge Waston Memorial Baptist Church 7217 Nachand Lane Louisville, KY 40218 and its officers, directors, employees, and agents from any and all claims or liabilities for any injuries or illness whatsoever, including without limitation, injuries, damages, or losses to my child's person and/or property, physical illness, emotional distress, or disability. Release of Liability

Student Information

Gender

Birth Date

Age Group

Food Allergies

Details

Medical Concerns

Details

In case of an emergency, what is the preferred hospital

I have more students to register