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_____________________________________________For God has not given us a spirit of fearfulness, but one of power, love, and

sound judgment. 2 Timothy 1:7

Bible StoriesGamesPrizesCraftsMusicFood

* Transportation will be available everyday to and from the church(If transportation is needed, make note of this on your registration form)

_____________________________________________For more information call Jesse Motley: 580-482-1775 or

Email: ebcjesse@sbcglobal.net

Please return Registration Form and Medical Release form to:

Emmanuel Baptist Church

800 North Forrest St.

Altus, OK 73521

Vacation Bible School

Emmanuel Baptist Church

Pre-K 6th Grade(completed)

July 15th 19th

Monday Friday

9:00 am 12:00 pm

* Free Snack provided everyday *

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Registration

FormChildsName

Parent/GuardianName

Address

(street address,city, state,and zip code)

Mailing Address(ifdifferent)

Phone NumbersHome

WorkCell

Email

Age Information

Birthdate

Lastgrade completed in school

Medical Information

Medical or other information we need to know. (Please include any

food allergies.)

Emergency Contacts(Other than listed above.)

Name Phone number_

Name Phonenumber_

Does your child need transportation? Yes No

Dismissal Information

Who may pick up your child at the end of each VBS day?

Other InformationDoes your child attend Sunday School? Ifso where?

Ifyour child is visiting our church, who is he/she a guest of?

May we have permission tophotograph your child? Yes No

May we have permission to use your childsphotograph forthe

purpose of promotion? Yes No

Administrative Guide CD, Registration Form 2012, LifeWay Christian Resources of the Southern Baptist Convention

VBS 2013 Published in the United States of America OK to Copy

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Emmanuel Baptist Church

Pastor: Boyd Whitehead

PARENTAL CONSENT AND MEDI CAL AUTHORIZATION: FI ELD TRIPS

I, ____________________________________________, the parent or legal guardian of

______________________________________________ do give consent to the participation of the child named

above for the year of 2013. I give consent for my child, listed above, to take part in any or all the activities,including but not limited to physical or athletic activities for the youth or children at Emmanuel Baptist Church,Altus, Oklahoma, including field trips.

______________________________________ _________________Signature of Parent/Guardian Date

______________________________________ _________________

Address Phone Number

MEDICAL TREATMENT AUTHORIZATION

I understand that I will be notified in the case of a medical emergency involving my child listed above. However,in the event that I cannot be reached, I authorize the calling of a doctor and the providing of necessary medicalservices in the event my child, listed above, is injured or becomes ill. I understand that Emmanuel Baptist Churchwill not be responsible as parent/guardian.

I agree to notify the church in the event of any health changes which would restrict my childs participation in any normal

youth activities. I also understand that the adult supervisors reserve the right to restrict my child from any activity that they

feel is not within the physical capabilities of my child.

___________________________Insurance Company

___________________________Insurance Company ID/Medicaid Number

___________________________ ____________Signature of Parent/Guardian Date

Emmanuel Baptist Church

800 North Forrest

Altus, OK 73521

(580)-482-1775