Vacation Bible School Registration

Mailing address, city, state, zip

Medical History

Does your child have allergies?
required
Option added and selected

If you answered yes to the question above, please answer.

Does your child take prescribed medications?
required
Option added and selected

If you answered yes to the question above, please answer

Has your child had COVID-19 in the last 14 days?
required
Option added and selected
Has your child been exposed to anyone with COVID-19 in the last 14 days?
required
Option added and selected

Transportation

Does your child need transportation to Vacation Bible School?
required
Option added and selected

If Yes, please contact the church office

Required Waiver of Responsibility

In consideration for attending this program, I, the undersigned, intending to be legally bound, hereby for myself, heirs and executive administrator, waive and release any and all rights for damages I may have with Community Baptist Church, and verify that I am voluntarily attending Vacation Bible School (VBS) at 2100 Durham Road, Langhorne, PA, with my parent and or legal guardian’s consent.

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