Adult VBS Registration

 

This registration form will be active through midnight on Saturday, June 25, 2011. Walk-in registrations will be accepted beginning Monday, June 27, at 8:30 am in the church lobby.

 
 

* - Indicates REQUIRED entry

  *
Adult Name:
  
 
Second Adult Name:
  
  *
Street Address:
  
  *
City:
  
  *
State:
  
  *
Zip Code:
  
  *
Phone:
  
  *
E-Mail Address:
  
 
Church Regularly Attending:
  
 
*
List names of all children attending VBS:
  

Child care will be provided for children who are too young to attend VBS, but whose parents/caregivers wish to attend the Adult Bible Study.

 
If you will need child care for little ones while you are attending Adult VBS, list the children's names and ages:
  
 
 

How did you find out about our VBS?
   *     I'm a UHBC member
        Received a 'Save the Date' postcard
        Read about it
 
If Read about it, please list publication:
  
        Saw it on the UHBC website
        Saw the banner on the front lawn
        Friend/family member told me
        Not a member, but look for VBS every summer
        Other
 
If Other, please list:
  
 
 

By checking the box below, you authorize and agree to the following:

1) I give the staff of University Hills Baptist Church's Vacation Bible School permission to administer first aid to me. If I am incapacitated, I hereby authorize University Hills Baptist Church staff/members to call a physician or to take me to the nearest hospital. I give permission to the physician selected by the University Hills Baptist Church staff/members to hospitalize and secure proper treatment for me. I do hereby release University Hills Baptist Church from any and all liability or claims for actions taken under this consent in good faith and further agree to indemnify University Hills Baptist Church and hold it harmless against all expenses incurred by it in relying in good faith on this consent.

2) I authorize the usage of images of me (i.e., photos, video) by University Hills Baptist Church and its assignees for any lawful purpose, including such purposes as publicity, illustration, advertising, etc., in print or electronic form.

        *I agree to the above statement
 

Clear

If you have any other questions, please email vbs@universityhills.org.