Agape VBS 2022 Student Registration

Agape VBS 2022 Student Registration

June 19-25, 2022 Monday through Friday 5 p.m. to 8 p.m.
Mother's Name *

First Name Last Name
Mother's email Address *
example@example.com
Mother's Cell Phone Number *
Please enter a valid cell phone number.
Father's Name

First Name Last Name
Father's Email Address
example@example.com
Father's Cell Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Student Name *

First Name Last Name
Student Date of Birth (must be 3 years old by June 1, 2022 to participate) *

Month Day Year
Date
Student Age by June 1, 2022 or Current Grade (2021-2022 School Year) *
Student Gender *

Male Female
T-Shirt Size *

Youth X-Small (2-4) Youth Small (6-8) Youth Medium (10-12) Youth Large (14-16) Youth X-Large (18-20)
T-shirt Deadline April 24 *

I am aware that students who register after April 24, 2022 may not receive a VBS t-shirt.

In consideration for my child being allowed to participate in VBS, AWANA, Harvest Festival, Sunday School, I release from liability and waive my right to sue Agape Christian Church of Orange County, their empoyees, officers, volunteers, and agents (collectively "Agape") from any and all claims, including claims of Agape's negligence, resulting in any physical injury, illness or economic loss I or my child may suffer or which may result from my or my child's participation in VBS, AWANA, Harvest Festival, Sunday School. My child the Participant. I have read this document, and I am signing it freely. I understand the legal consequences of signing this document, including (a) releasing Agape from all liability on my and the Participant's behalf, (b) waiving my right to sue Agape, (c) and assuming all risks of Participant's participation in VBS, AWANA, Harvest Festival, Sunday School. I allow the Participant to participate in all activities at VBS, AWANA, Harvest Festival, Sunday School, including but not limited to, zip-lining, bounce houses, and outdoor water activities. I understand that I am responsible for the obligations and acts of the Partiicpant as described in this document. I agree to be bound by the terms of this document.
I do hereby acknowledge and assume any and all risk of participation in any and all activities in association with Agape Christian Church OC. *

I do hereby acknowledge
Allergy Statement: On occasion, Agape Christian Church OC serves snacks that contain: peanuts, tree nuts (including coconut), dairy products, eggs, soy, wheat, crustaceans, fish. *

I do hereby acknowledge
Photos and Social Media Statement: Agape may use photos taken at VBS, AWANA, Harvest Festival, Sunday School and/or information related to my or my child's experiences at the aforementioned programs. This information may be used in electronic publications, audiovisual presentations, promotional literature, and social media. *

I do hereby acknowledge
COVID 19

Waiver-Release of Liability

Participants and volunteers agree to self-monitor for signs and symptoms of COVID-19 (symptoms typically include fever, cough, and shortness of breath) and refrain from participating if symptoms are present.
*

I do hereby acknowledge
Signature *

Clear

In the next field please include the FULL amount to be paid.
The minimum suggested donation for each child is $40

(Ex: 2 x $40 = $80)

You Will be redirected to PAYPAL for payment.

Please note REGISTRATION is not complete until payment is processed.

You will receive a Thank You for registering note at the end.
Minimum suggested donation per child is $40. *
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Total

$ 0.00
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