VBS 2023 at Northwest Community Church

VBS 2023 at Northwest Community Church - Registration Form
Child's Name*

First NameLast Name
Birth Date

MonthDayYear
Grade in school (Spring 2023)*
Email Address*
Phone # where you can be reached from 8:45- Noon*

Area CodePhone Number
Mom

First NameLast Name
Dad

First NameLast Name
Please list any allergies, food allergies, medical conditions or other information we may need to be aware of
PLEASE READ (and digitally sign below)

PARTICIPATION AGREEMENT FOR VACATION BIBLE SCHOOL AT NCC

I acknowledge that participation in Vacation Bible School (VBS) at Northwest Community Church involves risk to my child, and may result in various types of injury including, but not limited to, the following: sickness, exposure to infectious/communicable disease, bodily injury, death, emotional injury, personal injury, property damage, and financial damage. In consideration for the opportunity to participate in VBS, I, as the parent, acknowledge and accept the risk of injury associated with participation in VBS. I accept personal financial responsibility for any injury or other loss sustained during VBS.

Further, I release and promise to indemnify, defend, and hold harmless Northwest Community Church for any injury arising directly or indirectly out of participation in VBS.
DIGITAL SIGNATURE (typing your name in this box indicates your acknowledgement of the above authorization & consent)*

First NameLast Name
PLEASE INDICATE TODAY'S DATE*

MonthDayYear
Date
AUTHORIZATION & CONSENT FOR USE OF PHOTOS

I authorize and consent to the use of images or videos of my child listed above, with or without their name, by Northwest Community Church of Malcolm, Nebraska for purposes including but not limited to: promotional materials, printed publications, internet posts including social media, and other media sources.

I do this with full knowledge and consent and waive all claims for compensation for use or for damages. I release Northwest Community Church, its officers, trustees, employees, and agents from liability for any claims by me or any third party in connection with the use of the image of my child listed above.
DO YOU AUTHORIZE THE USE OF PHOTOS AS DESCRIBE IN THE SECTION ABOVE?*

YES, I authorize the use of photos of my child listed aboveNO, I do NOT authorize use of photos of my child listed above
PLEASE INDICATE TODAY'S DATE*

MonthDayYear
Date
DIGITAL SIGNATURE (typing your name in this box indicates your acknowledgement of the above authorization & consent)*

First NameLast Name
Should be Empty:

VBS 2023 at Northwest Community Church - Registration Form