Vacation Bible School Signup Form
August 4th-8th 6:00pm-8:30pm
Name of the Child
First Name
Last Name
Age
Gender
Male
Female
Grade Level
Please Select
Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Phone Number
Please enter a valid phone number.
Is he/she carrying an Epi-pen at all times?
Yes
No
Does your child have any allergies?
Yes
No
What are the allergies of your child?
Does your child have any medical condition that we should be aware of?
Yes
No
What is this medical condition? Please elaborate below:
Pick Up Authorization
Authorized person/s to pickup your child after the Vacation Bible School
Full Name 1
First Name
Last Name
Relationship
Full Name 2
First Name
Last Name
Relationship
Emergency Contact Information
Emergency Contact 1
First Name
Last Name
Relationship
Phone Number
Please enter a valid phone number.
Emergency Contact 2
First Name
Last Name
Relationship
Phone Number
Please enter a valid phone number.
Permission/Release of Treatment
I hereby give my child permission to participate in The Father's House Kids program, (including but not limited to services, activities, special programs, Vacation Bible School) under the supervision of the group leaders and volunteers. I release, and discharge any and all claims, demands and causes of action against The Father's House, their agents, employees, volunteers and participants arising from any damages, property loss or injury my child may sustain. I declare that the information I provided is accurate and current. I understand that The Father's House insurance policy provides secondary coverage for my child, that my coverage is primary, and I hereby accept all responsibilities for medical costs. I further consent to allow The Father's House supervising staff to seek and obtain medical treatment for this child as needed. I hereby state that I understand and accept the conditions therein and that this signed form will be utilized and kept on file for this event and I will contact The Father's House if any of this information changes.
Would it be okay if we take photos and videos of the participant during the activity which will be posted in our social media account?
Yes
No
Digital Signature-Full name
Date Signed
-
Month
-
Day
Year
Date
Submit
Should be Empty: