Gathering Church VBS 2023 Registration Form

Gathering Church Vacation Bible School

June 4-8 5:30-8:00 pm **For kids entering Kindergarten through kids exiting 5th Grade**
Child's Name

First NameLast Name
Birthdate

MonthDayYear
Date
Grade Completed

PreKKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade
Gender

MaleFemale
Allergies or Special Concerns
Parent/Guardian Information
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Cell Number

Area CodePhone Number
E-mail
Emergency Information
Emergency Contact

First NameLast Name
Emergency Contact Number

Area CodePhone Number
Relationship
Liability Release and Medical Authorization

In consideration for the child’s participation in Gathering Church's Vacation Bible School, I, being 21 years of age or older, do for myself and on behalf of the minor child do hereby assume all risk and release, forever discharge and agree to hold harmless Gathering Church, its staff and agents thereof from any and all liability, claims, or demands for personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned or child while participating in Vacation Bible School. I understand recreation activities and other physical activity will be part of the event. I am the parent or legal guardian of this child, and hereby grant my permission for him/her to participate fully in said activities, and hereby give my permission to take the child to a doctor or hospital in the event of an emergency and hereby authorize treatment, and we assume the responsibility of all medical bills, if any.
By signing in the box, I agree to the liability release and medical authorization above.

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Photo Release

We plan to make a recap video of the week to share the final night of VBS and on the Sunday morning following VBS. I give permission for photographs/videos of the persons listed above to be used in publications of Gathering Church (including the church website and Facebook pages). No identifying information will be displayed.
By signing in the box, I agree to the photo release above.

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Should be Empty:

Gathering Church Vacation Bible School