VBS Registraion Form (Please fill out one form PER child)
VBS @ Liberty MBC is July 22nd from 8:30-2:30pm
Each volunteer at Liberty has gone through an extensive background check to insure the safety of each child here. You can relax knowing their safety is our top priority! We will provide snacks, drinks, and lunch for each child, so it is very important that you list any food allergies on the registration form. VBS will end at 2:30pm, so please be here to pick up your child/children at that time (unless they are riding home on the Church van). We will NOT release your child/children to anyone other than who is listed on the bottom of the registration form. If there is a change to who will pick up your child/children, please call or text the VBS Director, Stacy Pickard, at 214-592-6416 before VBS is over.
Child's Name
*
First Name
Last Name
Child's Age
*
Grade just completed
*
Please Select
Nursery Age (under 2)
Pre-K
Kinder
1st
2nd
3rd
4th
5th
6th
Please list any allergies that your child has. We are serving snacks and lunch, so this is important! If your child has no allergies, please put N/A.
*
Permission to photograph
*
Please Select
Yes
No
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Emergency Contact Name(If we are unable to reach YOU)
*
First Name
Last Name
Emergency Contact's Phone Number
*
Please enter a valid phone number.
How will your child get home after VBS?
*
Will be picked up
Needs to be driven home on the church van
If your child is being picked up after VBS (not being transported on Liberty's church van) please list the name of who will be picking up your child. We will NOT release your child to anyone other than who is listed here. If there is a change in this before VBS is over, please text VBS Director, Stacy Pickard at 214-592-6416 to notify us of this change.
First Name
Last Name
LIABILITY RELEASE: In consideration of Liberty MBC allowing the Participant to participate in VBS, I, the undersigned, do hereby release, forever discharge and agree to hold harmless Liberty MBC, its Pastors, Board Members, directors, employees, volunteers and teachers (collectively herein the “Church”) from any and all liability, claims or demands for accidental personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the Participant while involved in the activities. I the parent or legal guardian of this Participant hereby grant my permission for the Participant to participate fully in VBS activities. Furthermore, I, on behalf of my minor Participant, hereby assume all risk of accidental personal injury, sickness, death, damage and expense as a result of participation in recreation and work activities involved therein. The undersigned further hereby agrees to hold harmless and indemnify said Church for any liability sustained by said Church as the result of the negligent, willful or intentional acts of said Participant, including expenses incurred attendant thereto.
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