Sunday School Ministry Survey

vacation bible school registration

June 17 - 21, 2019

6:30 - 8:45 pm

Child's Name (one form per chid) *
Child's Name (one form per chid)
Parent's Name(s) *
Parent's Name(s)
Home Address *
Home Address
Home Phone *
Home Phone
Alternative Phone
Alternative Phone
Emergency Contact Person *
Emergency Contact Person
Home Phone *
Home Phone
Alternate Phone
Alternate Phone
Doctor's Phone *
Doctor's Phone
Name of person who may pickup the child *
Name of person who may pickup the child
Number of person who may pickup the child *
Number of person who may pickup the child
Name of additional person who may pick up the child
Name of additional person who may pick up the child
Number of additional person who may pick up the child
Number of additional person who may pick up the child

PARTICIPANT MEDICAL AUTHORIZATION, WAIVER OF LIABILITY, CONSENT TO IMAGE RECORDING AND USE

(1) If reasonable attempts to contact me have been unsuccessful in an emergency, I hereby give permission to Mt. Zion Baptist Church and its Vacation Bible School to secure necessary emergency treatment including transport to a local hospital and for any licensed physician or dentist to administer any treatment considered necessary, understanding all charges are at my expense

(2) For and in consideration of permitting the person indicated above to enroll in and participate in Vacation Bible school at Mt. Zion Baptist Church, I, my child(ren), my executors and assigns, hereby voluntarily and forever release, discharge and relinquish Mt. Zion Baptist Church, its agents, officers, employees, and volunteers from any and all actions, causes of action, and claims for personal injury, permanent loss, or property damage of or to the participant arising out of, or in any way related to, their participation in such program, even though that liability may arise out of the negligence or carelessness of Mt. Zion Baptist Church or its officers, agents, employees, or volunteers.

(3) consent for my child’s image to be recorded, either by photograph or video, and used during the VBS week or for advertisement of Mt. Zion Baptist Church and/or its VBS programs through all forms of print and social media.  I have read this entire waiver and permission form, fully understand it, and agree to be legally bound by its terms.

MZBC Community golf registration form

Saturday, July 27, 2019

Forest Green Golf Course

4500 Poa Annua Ln.

Triangle, VA 22172

703-221-0123

7th Annual Golf Outing

Four golfers scramble

Registration: 7:30 am Shotgun Start: 8:30 am Cost: $100 per golfer

The includes range balls and 18-holes of golf, riding cart, lunch, and chance to win various prizes!

*Men and Ladies Longest Drive

*Men and Ladies Closest to the Pin

POC:

Deacon Stan Wooten 540-659-2526

Deacon Billie Keeler 703-402-1554

Deacon Willie Randle 703-945-9271

To make payments:

  1. Make check payable to Mt. Zion Baptist Church 18410 Chapel Dr. Triangle, VA 22172

  2. Make check payable to Deacon Stan Wooten

  3. Make check payable to Deacon Billie Keeler

  4. Pay online by clicking here

Player Name #1 *
Player Name #1
Player #1 Phone Number *
Player #1 Phone Number
Player Name #2 *
Player Name #2
Player #2 Phone Number *
Player #2 Phone Number
Player Name #3 *
Player Name #3
Player #3 Phone Number *
Player #3 Phone Number
Player Name #4 *
Player Name #4
Player #4 Phone Number *
Player #4 Phone Number