Register for VBS

Address

Primary Phone

Phone Number

Emergency Contact Phone Number

Relationship to Student Father Mother Grandfather Grandmother Great-grandfather Great-grandmother Brother Sister Uncle Aunt Guardian Foster Parent Granduncle Grandaunt Other

Is your family actively attending church?

Student Information

Gender

Age Group

Birthdate

Food Allergies

Details

Medical Concerns

Details

Participation Agreement YES By selecting yes, the participant (or parent/guardian if participant is a minor) acknowledges and excepts the risk of physical injury associated with participation in the activity described above. Except for gross negligence on the part of the sponsor, the participant (or parent/guardian) accepts personal financial responsibility for any bodily or personal injury sustained during the activity. Further, the participant (or parent/guardian) promises to hold harmless the sponsoring organization and it's representatives for any injury related to the activity. If dispute over this agreement or claim for damages arises, the participant (parent/guardian) agrees to resolve the matter through a mutually acceptable arbitration process.

Photography/video permissions YES NO By selecting yes, you give permission for VBS volunteers to take photos/videos of your child during VBS activities. These photos may be used in the following ways: church website, church social media pages, newsletters, or community newspapers. Photos posted to church website or social media will not include names or ages of children.

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