Vacation Bible School

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Child's name (1st Child)

First

Last

Child's name (2nd Child)

First

Last

Child's name (3rd Child)

First

Last

Child's name (4th Child)

First

Last

of or date

Child's date of birth (1st Child)

Child's date of birth (2nd Child)

Child's date of birth (3rd Child)

Child's date of birth (4th Child)

What grade is the child in? (1st Child)

If between grades, list the grade the child will be in at the start of the next school year.

What grade is the child in? (2nd Child)

If between grades, list the grade the child will be in at the start of the next school year.

What grade is the child in? (3rd Child)

If between grades, list the grade the child will be in at the start of the next school year.

What grade is the child in? (4th Child)

If between grades, list the grade the child will be in at the start of the next school year.

Does your child or children have any food allergies or medical conditions?

If yes, please list the food allergies or medical conditions

Child's Doctor and Phone Number

Parent/Guardian Name

First

Last

Parent/Guardian Email

Parent/Guardian Phone

Home Address

People who are authorized to pick up your child or children (name and phone number):

Picture Permission

I agree and give my permission

I give permission for Landmark Baptist Church staff and VBS volunteers to use the above-named child’s photograph publicly to promote the church or VBS. I understand that the images may be used in print publications, online publications, presentations, websites, and social media.

Parental Authorization

I agree and give my permission

I give permission for the above-named child to attend Vacation Bible School (VBS) at Landmark Baptist Church of Loudon NH on July 20-24, 2026. I hereby agree to RELEASE, INDEMNIFY, and HOLD HARMLESS, Landmark Baptist Church, its’ employees, volunteers, and agents, from any and all liability which may arise from my child’s participation in the above-mentioned activities. Liability to extend to any accidents, illnesses or injuries (including the possibility of death) which may either directly or indirectly befall my child while participating in the above mentioned program. In the event that a medical emergency shall befall my child, I now provide a member of the Landmark Baptist Church VBS team, the ACTING POWER OF ATTORNEY, to initiate and oversee any emergency medical care that may be deemed necessary on my child’s behalf until a time when I may be present to authorize the same.