Vacation Bible School Registration

Campers Name #1:

First NameLast Name

Age:

Grade Completed:

Shirt Size

Campers Name #2:

First NameLast Name

Age:

Grade Completed:

Shirt Size

Campers Name #3:

First NameLast Name

Age:

Grade Completed:

Shirt Size

Campers Name #4:

First NameLast Name

Age:

Grade Completed:

Shirt Size

Campers Name #5:

First NameLast Name

Age:

Grade Completed:

Shirt Size

Parent/Guardian:

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Cell Phone:

Area CodePhone Number

Home Phone:

Area CodePhone Number

E-mail:

example@example.com

Emergency Contact:

First NameLast Name

Emergency Contact Phone:

Area CodePhone Number

Do you have a church home? If so, where?

Do you have a friend that you would like to be in the same group with? If so, who is that friend?

Who is Picking up Child:

Special Needs / Allergies / Concerns:

Release of Risk Assumption

General
I, the undersigned, have legal custody of the child/children named below and have given consent for his/her/their participation in events being organized by Helenwood Baptist Church. I hereby waive and release Haven Of Hope Ministries Inc., Helenwood Baptist Church, their pastors, workers, volunteers, owners, employees, and agents, including but not limited to Randall C. Glenn & Kristalina D. Glenn, from liability of any nature. This includes but is not limited to injury, loss, damage to person or property, or other misfortune resulting from any recreational or educational activity, including but not limited to horseback riding, grooming, walking or leading, which may take place at the farm, church, or at any other location. I understand that there are inherent risks of injury, damage, or other misfortune involved with these recreational, educational, and ministry activities. I am fully aware that there is a risk, and I accept the risk of such activities. I acknowledge that such activities are for recreation, sport or education, and I undertake them voluntarily. By signing below, I acknowledge and accept the risk of physical injury associated with participation in the activities and promise to hold harmless Helenwood Baptist Church and its representatives for any injury related to it.

Medical
In the event that he/she is injured and requires medical attention, I consent to any reasonable medical treatment of my child as deemed necessary by a licensed professional. In the event treatment is required from a physician and/or hospital personnel, I agree to hold such person free and harmless of any claims, demands, or suits for damages arising from the giving of such consent. I also acknowledge that I will be ultimately responsible for the cost of any medical care should the cost of that medical care not be reimbursed by the health insurance provider.

Horseback Riding
We ask that all friends, family, and guests stay out of all barns, paddocks, tack room, and corrals while waiting for a horseback ride or other related activity. ln consideration of the permission to participate extended to me and for the services rendered by Haven of Hope Ministries, Inc. and Helenwood Baptist Church, I do hereby for myself, heirs, personal representatives and agents, forever release and discharge my claims, demands, actions, or lawsuits that may occur as a result of negligent, but not reckless, or intentional conduct during my participation.

I agree with the Release of Risk Assumption outlined above.

Signature