VBS 2022 Registration and Release Form

Welcome to Vacation Bible School 2022 at Memorial Baptist Church

Registration and Release Form
Parent/Guardian Information
Parent Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number

Area Code Phone Number
Email *
example@example.com
Relationship to Child(ren) *
Church Currently Attending *
Emergency Information

Individuals to contact in case of an emergency if parents are unavailable
Emergency Contact #1 *

First Name Last Name
Phone Number *

Area Code Phone Number
Emergency Contact #2

First Name Last Name
Phone Number

Area Code Phone Number
Child(ren) Information
1st Child Name *

First Name Last Name
Gender *

Male Female
Date of Birth

Month Day Year
Age *
Grade Completed *
Please list any allergies or special conditions (if none, please state none) *
Please try to place me in a group with:
Please give child's first and last name. We will do our best to group selected friends together in the same crew, but we cannot promise all requests will be possible.

2nd Child Information (if applicable)
2nd Child Name

First Name Last Name
Gender

Male Female
Date of Birth

Month Day Year
Age
Grade Completed
Please list any allergies or special conditions (if none, please state none)
Please try to place me in a group with:
Please give child's first and last name. We will do our best to group selected friends together in the same crew, but we cannot promise all requests will be possible.

3rd Child Information (if applicable)
3rd Child Name

First Name Last Name
Gender

Male Female
Date of Birth

Month Day Year
Age
Grade Completed
Please list any allergies or special conditions (if none, please state none)
Please try to place me in a group with:
Please give child's first and last name. We will do our best to group selected friends together in the same crew, but we cannot promise all requests will be possible.

First Aid and Emergency Medical Treatment

If a parent is not on church grounds at time of incident
By signing at the end of the form and initialing here: initials*
I hereby give written permission for my child(ren) to attend and participate in all Children's Ministry activities at Memorial Baptist Church.

As a parent/guardian, I do hereby authorize the treatment of my child(ren) by a qualified and licensed medical doctor in an emergency which, in the opinion of the attending physician, may endanger his/her life, care, cause disfigurements, physical impairments, or undue discomfort if delayed.

The authority is granted only after a reasonable effort has been made to reach me.
Digital Image and Video Recording Permission
Memorial Baptist Church regularly takes photographs or makes audio/video recordings of children and/or adults involved in church activities.

By signing at the end of the form and initialing here: initials*

I understand that by participating, my child may appear in such photographs and audio/visual recordings which may be used in Memorial Baptist Church's publications or advertising materials to let others know about the church's ministries.

If I wish to opt out, I will personally contact the Children's Minister Rachael Gomez at rachael@mbcmetairie.org so that special accommodations can be made.
Pickup Procedures
By signing at the end of the form and initialing here: initials*

I understand, for safety purposes, that I must present the security claim tag assigned to me or a digital image of the tag in order to obtain my child(ren) from Vacation Bible School once they are checked in.
Communication Options
Select the communication option you would like to receive:

WEEKLY TEXT of all MEMORIAL BAPTIST activities and events WEEKLY TEXT of KIDS activities and events WEEKLY EMAIL of activities and events

COVID-19
By signing below and initialing here: initials*

I, on behalf of myself and my dependents, hereby assume all the risks of requesting this service, including by way of example and not limitation, any risks that may arise from contracting the COVID-19 virus from this service provider, gross negligence or carelessness on the part of the service provider, and release my service provider from any and all liability from any medical condition, viruses, of the service provider and contracting such viruses from the service provider. This waiver and release of liability covers any negligence or gross negligence in relation to exposing me or my dependents to the COVID-19 virus and understand the potential for infection despite all CDC-recommended precautions that will be taken. I understand utilization of services is completely voluntary, and I assume all the risks as a result.

I am responsible for determining whether a physical or medical examination should be undertaken before I or my dependents participate in the services being provided, and I will abide by any determination, limitation, or recommendation that may be issued by my medical or health care provider. Before, during, and after the services, I am solely responsible for determining my and my dependent’s health and physical status and whether I or my dependents can or should discontinue my participation in the services, or take other actions, to protect my own, and my dependents, health or safety. Service provider assumes no duty to me or my dependents to ensure my physical or medical ability to participate in the services, whether before, during, or after the services.

I acknowledge that this waiver and release of liability form will govern my actions and responsibilities at said services, activity, or event. In consideration of providing services to me and/or my dependents, I hereby take action for myself, dependents, my executors, administrators, heirs, next of kin, successors, and assigns as follow:

(A) I waive, release and discharge from and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from this event, the following entities or persons: service provider and its directors, officers, employees, representatives, employee, and agents:

(B) I indemnify, hold harmless, and promise not to sue the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this service, activity, or event, whether caused by the negligence of release or otherwise. My and my dependent’s participation in the services is voluntary.

I acknowledge that this service provider and its directors, officers, employees, representatives, and agents are not responsible for the contamination, errors, omissions, acts, or failures to act of any party or entity conducting in providing the services. The accident waiver and release of liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.
On behalf of myself and my dependents *
Parent Name
Date *

Month Day Year
Date
Signature *

Clear
Should be Empty:

Welcome to Vacation Bible School 2022 at Memorial Baptist Church

Parent/Guardian Information

Emergency Information

Child(ren) Information

First Aid and Emergency Medical Treatment

Digital Image and Video Recording Permission

Pickup Procedures

Communication Options

COVID-19