VBS Registration

VBS Registration Form 2017

Child's Name *

First

Last

Age *

Date of Birth *

Medical Information, Allergies or Special Needs: *

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? *

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? *

If Yes, please clarify. *

Photo Release

Do we have permission to photograph your child? *

May we use your Child's photograph in church publications for the purpose of promotion? *

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