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VBS Registration Form 2018
*
Indicates required field
Child's Name
*
First
Last
Age
*
5
6
7
8
9
10
11
12
Date of Birth
*
Please Use this format: 01/10/2005
Medical Information, Allergies or Special Needs:
*
If none, type "N/A"
Alternate Emergency Contact
*
First
Last
Phone Number
*
Relationship
*
Parent/Guardian Name
*
First
Last
Primary Phone Number
*
Secondary Phone Number
*
Email
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Do you have a regular Church home?
*
Yes
No
If yes, Church you are currently attending
*
I am a guest of:
*
Dismissal Information
***Children will not be released to anyone under the age of 18 years old.
Who is allowed to retrieve this child at the end of VBS?
*
Are there custody issues involving this child?
*
Yes
No
If Yes, please clarify.
*
Photo Release
Do we have permission to photograph your child?
*
Yes
No
May we use your Child's photograph in church publications for the purpose of promotion?
*
Yes
No
Having been made aware of the activities the student will be doing, I hereby consent to the student’s participation in the Glendale Christian Church VBS (Vacation Bible School). I voluntarily release and forever discharge Glendale Christian Church and all VBS Volunteers from any and all liability, claims, actions or rights of action which are in any way related to the student’s participation in the event’s activities. I agree to indemnify and hold Glendale Christian Church and the VBS Volunteers harmless from any and all costs or damages, including attorney fees, incurred in connection with the student’s participation in event activities. I further agree not to sue, assert or otherwise maintain any claim or cause of action against Glendale Christian Church or the VBS Volunteers arising from the student’s participation in Glendale Christian Church's Vacation Bible School. In case of emergency, I understand that every effort will be made to contact parents or guardians of minor students. However, if parents or guardians cannot be reached, I hereby give Glendale Christian Church and any acting adjent thereof permission to act on my behalf in seeking and administering medical treatment in the event that such treatment is deemed necessary or advisable for the student’s health, safety, and welfare. I release Glendale Christian Church and all VBS Volunteers from liability in acting on my behalf in this regard and rendering such medical treatment. I assume the risk and financial responsibility for any injury or illness resulting from the student’s participation in event activities.
Parent/Guardian Signature
*
First
Last
*By typing your name here you are affirming that you are the parent and/or guardian of the child and that the above information is accurate.
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