FBC Williams Arizona
Wednesday, May 22, 2019
Changing Hearts, Changing Lives, One Soul at a Time

VBS Forms

Child’s Name_____________________________________________________
Parent/Guardian Name _____________________________________________________________
Address :   (street address, city, state, and zip code)



Mailing Address (if different)  _______________________________________________________

Phone Numbers:     Home______________________   Work _____________________  Cell ___________________Email: ________________________________________

Age Information:   Birth date ________________  Last grade completed in school____

Medical or other information we need to know. (Please include any food allergies.)
Emergency Contacts: (other than listed above) Names & Phone numbers : ___________________________________________________________________
Dismissal Information Who may pick up your child at the end of each VBS day?_____________________________
Other Information:
 Does your child attend Sunday School? ð YES  ð NO        If so where? _________________________________________________
If your child is visiting our church, who is he a guest of?_________________________________________________
May we have permission to photograph your child?    Yes           No

May we have permission to use your child’s photograph for the purpose of promotion?    Yes          No


VBS - Van Information Form - (Fill out if your Child Needs a ride) 
If your children need a ride to and from VBS, FBCW will provide Free transportation via our Van. 
Please fill out the following information and permission slip.
The van driver will contact you for a pick up time.
Parent/Guardian name: ____________________________________________
Phone number: ____________________________
How many children will need transportation? _______________
List the name(s) below:
Address where child will be picked up: _________________________________
Directions to address: ______________________________________________ 
(Note: No Child will be transported, in the van without proper paper work in place)

Child’s Name:                                                                                   Birth Date: _____________________ 
Address: ______________________________Phone number:                                             
I give permission for my above-named Child to attend First Baptist Church of Williams AZ, VBS. I understand that my Child will travel in the Church’s van owned and operated by FBC of Williams. 
I hereby release First Baptist Church of Williams, AZ Inc., its staff, its Pastor and representatives, from all responsibility and liability for any injury or illness my child may sustain during an activity or when being transported in the FBCW Van. In the event of an emergency, I hereby authorize the leadership of this and all VBS Ministry activities, as agent for me, to consent to any x-ray, medical examination, medicinal treatment, dental or surgical diagnosis & treatment, hospital care advised and supervised by a physician, surgeon or dentist (as appropriate) licensed to practice under the laws of the state where the services are rendered, either at a doctor’s office or in any hospital or Urgent Care Center. I expect to be contacted as soon as possible regarding my Child’s accident, illness or condition. Dated ______ 

Signature(s) of Parent(s) or Legal Guardian(s):

                                                                                           Contact Phone #                                                              
                                                                                           Contact Phone #                                                              
Secondary Emergency Contacts (names): (Required) 
                                                                                                Contact Phone # ____________________
                                                                                                Contact Phone # ____________________ 
Allergies (including food):                                                                                                                                           
Medications Presently Being Taken*:                                                                                                                         
*All Medications must be given to the VBS Director if needed during VBS*

Physical Handicaps, Needs or Restrictions                                                                                                               

Family Physician’s name:                                                                                     Phone # _________
INSURANCE INFORMATION(Copy from Insurance card): 
Medical Insurance Carrier:                                                                                                                            
Policyholder’s Name:                                                                                                                                     
Policyholder’s ID #                                                                                                                                          
Policy #: