* First Name
* Last Name
Group (Do Not Fill Out)
* Grade Finished
* Age
* Address
* City
* State
* Zip
* Home Phone
* Email
* Home Church
If your Church's name doesn't appear above please insert in box below
  Church Name if not in list
* Allergies / Medical
* Parent First Name
* Parent Last Name
* Emergency Contact
* Emergency Phone
* Tee Shirt Size
Special Instructions

Medical Release

(We) (I) hereby grant permission to First Baptist Church of Hampton Falls to secure medical care as (above) child may require for the period of July 13-17, 2009 including examination, treatment, and immunization. This permission is conditional upon the understanding that in the event of serious illness or the need for operation and/or major surgery, Hampton Falls Baptist Church, guardian, will use all reasonable efforts to contact me. Failure in such efforts, however, should not prevent Hampton Falls Baptist Church, guardian, from providing such emergency treatment as may be necessary for his/her best interest.



Photo Permission

Permission to use child's picture on VBS web site (no names will be used)?



5th & 6th Grade Parents Only

I am aware that 5th and 6th graders may take local field trips during the week of Vacation Bible School.