Please use this registration form for pre-registration for Mount Vernon's Vacation Bible School and/or Youth Lock-in. There are classes for all age groups - so, go ahead and register the entire family.

Name of Participant*

Gender*

Last School Grade Completed

Are you a member of Mt. Vernon?

Street Address

City, State, Zip Code

Home Phone

Cell Phone

Email address

Emergency Contact Person: (please include a name and number to contact in case of an emergency)*

Allergies or other medical conditions:

Additional Youth with Same Contact Information: (Please include name, age, date of birth, and last grade completed for each person. If participants have medical issues, please submit a separate form so that the church is aware.)

Additional Youth with Same Contact Information: (Please include name, age, date of birth, and last grade completed for each person. If participants have medical issues, please submit a separate form so that the church is aware.)

I understand that submitting this form grants permission for the above named person(s) to attend Vacation Bible School. In the event of an emergency where medical treatment is required, I give permission to the church staff to obtain the services of a licensed physician. I understand that I or the emergency contact person will be notified as soon as possible concerning any such emergency. I hereby release and discharge the adult leaders, volunteers, event staff and Mount Vernon Missionary Baptist Church from any and all debts, judgments or suits of any kind that may arise by my child’s participation in this event. Payment of any medical expenses will be paid by me or by my insurance company. I also understand that a photo of my child may appear on the church website of Mount Vernon or on other promotional material in the future.

COMMENTS: