Mount Vernon Baptist Church - AR

Jesus said, "Let the little children come to me..."

Matthew 19:14

Click here: Sign up for Vernkids Parent remind to get important information

Click here: WEEKLY VAN CONFIRMATION - must complete by tuesday night

2024-25 Student Registration

Parent/Guardian First Name

Parent/Guardian Last Name

Phone Number

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Child First Name

Child Last Name

Birthdate

Grade

Gender

Allergies

How will Student(s) will go home?

I am a volunteer & will pick up

Car Rider

Van Rider (WEEKLY CONFIRMATION REQUIRED)

Do we have permission to photograph/video your child and use in promotions?

Yes

DO YOU AGREE...Medical Release: By Submitting this registration, I, the parent or legal guardian of the student(s) listed in this form do authorize and execute consent for any and all medical and hospital care and treatment deemed necessary for the health and wellbeing of the student(s). Hold Harmless Statement: By submitting this registration, I, the parent or legal guardian of the student(s) release Mt. Vernon Baptist Church and any of its agents from any claims or liability arising from my children's participation in all student ministry and church activities. I agree to hold Mt. Vernon Baptist Church free, clear, and harmless from any and all claims and demands for, but not limited to personal injury and property damage arising out of my children's participation in these activities. I give permission for the student(s) listed on this form to participate in and attend the activities of Mt. Vernon Baptist Church; including riding in a church van or vehicle with a representative from Mt. Vernon Baptist Church. I understand it is my responsibility to report any changes in information contained on this form to the church office. I also understand that I must report any special medical treatment that may be needed for my student(s).

Yes

Signature

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