Houston Berean SDA Church

Worship. Discipleship. Relationship. Stewardship.

2023 Child Information Form

Select the Program for Which You're Registering Children's Church VBS (Vacation Bible School) Other (please let us know in the "Additional Information section")

Parent/Guardian's Name

Address

Home Phone

Cell Phone

Home Church

Child Information

Child 1 - Name

Child 1 - Date of Birth

Last Grade Completed

Child 1 Shirt Size

Child 2 - Name

Child 2 - Date of Birth

Last Grade Completed

Child 2 Shirt Size

Child 3 - Name

Child 3 - Date of Birth

Last Grade Completed

Child 3 Shirt Size

Child 4 - Name

Child 4 - Date of Birth

Last Grade Completed

Child 4 Shirt Size

Additional Information

Allergies

Additional Information- Please include any additional information below.

Photo/Video Release

Photographs and/or video will be taken and possibly used for publications related to Houston Berean SDA Church, such as church bulletins, newsletters, presentations and website. As a Parent/Guardian, I give permissions to Houston Berean SDA Church to photograph and/or record my child/children.

In according with current Berean Photo Release Statement, I grant permission for my child to be photographed. Select Yes if you agree. Yes No

Medical Release

As a parent/guardian, I authorize the treatment by a qualified doctor of the minor(s) listed in the event of an medical emergency while participating in at Houston Berean SDA Church.

Medical Release Authorization Yes No

Volunteer

May we contact you about volunteering? Yes No

Final Authorization

By selecting I DO agree below, I attest that I am the parent/guardian for the child(ren) listed and all information provide above has been answered fully and correctly.

Final Authorization Yes No

Related Information

Children's Ministries VBX 2023 Registration and Information