VBS Registration Form

VBS Registration

July 10th - 14th 6:00PM - 8:00PM
Child's Information
Child's Name

First NameLast Name
Birth Date

MonthDayYear
Grade Just Completed
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name

First NameLast Name
Home Number
Cell Number
E-mail
example@example.com
Emergency Information
Emergency Contact's Name (in the event a parent can not be reached)

First NameLast Name
Relationship
Phone Number
Alt. Phone Number
Does the child have any allergies, chronic illness, or medical conditions? If yes, please describe.
Is the Child prescribed an inhaler? If yes, please explain any instructions.
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Hope Lutheran Church during VBS. In exchange for the acceptance of said child’s candidacy by Hope Lutheran Church, I assume all risks and hazards incidental to the conduct of the activities and release, absolve, and hold harmless Hope Lutheran Church, and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from VBS.

In case of injury to said child, I hereby waive all claims against Hope Lutheran Church including all volunteers, all participants, owners, and lessors of premises used to conduct the event.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Date

MonthDayYear
Date
Signature

Powered by Jotform SignClear
Should be Empty:

VBS Registration

Child's Information