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CLICK HERE: WEEKLY VAN CONFIRMATION - MUST COMPLETE BY TUESDAY NIGHT
2024-25 Student Registration
Parent/Guardian First Name
Parent/Guardian Last Name
Phone Number
Email
Address
Apartment, suite, etc.
City
State
Zip/Postal Code
Child First Name
Child Last Name
Birthdate
Month
January
February
March
April
May
June
July
August
September
October
November
December
Date
1
2
3
4
5
6
7
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10
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16
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31
1912
1913
1914
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1917
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1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
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1936
1937
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1939
1940
1941
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1961
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1966
1967
1968
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1972
1973
1974
1975
1976
1977
1978
1979
Year
1980
1981
1982
1983
1984
1985
1986
1987
1988
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1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
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2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
Grade
0-18month (Worker Children Only)
18 Month - 3yr (Worker Children Only)
3-4 yr old
Pre-K (4-5yr old)
K
1
2
3
4
5
6
7
8
9
10
11
12
Gender
Male
Female
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
No
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
No
Signature
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Student Ministries
Sunday Morning Bible Study
9:45 am - 10:30 am
Small group Bible study for 7th - 12th grade students
Wednesday - The Shed
5:30 pm - 7:30 pm
Small groups for 7th - 12th grade students
Meal provided
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