VBS Registration Form

 
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CHILD'S INFORMATION
Name
Name
FAMILY INFORMATION
Parent/Guardian's Name
Parent/Guardian's Name
Home Address
Home Address
Phone
Phone
EMERGENCY CONTACT
Name
Name
Phone
Phone
I understand that reasonable precautions will be taken to safeguard the health and well being of the participants in this VBS and that I will be notified as soon as possible in the event of an emergency. In the case of sickness or an accident, I authorize and consent the VBS Team, or other associated volunteers of the VBS program to obtain medical care from a licensed physician, hospital, or medical clinic for my son/daughter in the event that myself or other legal guardian(s) cannot be reached. I herby do release and forever discharge Summit Christian Church (“SCC”) from all manners of actions, claims, which I or the child named above shall or may have for any reason, arising during my child’s attendance of the VBS. Unless other written instruction is submitted, I also consent to allowing my child’s image to be recorded, either by photograph or video, and used during the VBS week or for future advertisement of SCC’s VBS programs. Any other use will require your further consent.
Date
Date