VBS 2022 Child Registration

VBS Registration

August 8-11, 2024
This form is for 4 or less children. If you are registering more thatn 4 children please complete additional forms for each 4 chiildren.
Children's Information
Child 1 Name*

First NameLast Name
Child 1 Birth Date*

MonthDayYear
Child 1 Grade*
Child 1 Shirt Size*
Does Child 1 have any chronic illnesses, or medical conditions? If yes, please describe.*
Child 2 Name

First NameLast Name
Child 2 Birth Date

MonthDayYear
Child 2 Grade
Child 2 Shirt Size
Does Child 2 have any chronic illnesses, or medical conditions? If yes, please describe.
Child 3 Name

First NameLast Name
Child 3 Birth Date

MonthDayYear
Child 3 Grade
Child 3 Shirt Size
Does Child 3 have any chronic illnesses, or medical conditions? If yes, please describe.
Child 4 Name

First NameLast Name
Child 4 Birth Date

MonthDayYear
Child 4 Grade
Child 4 Shirt Size
Does Child 4 have any allergies including food allergies and sensitivities? If yes, does your child carry an Epinephrine Injector (EpiPen, Auvi-Q Pen, etc)?
Parent/Guardian Information
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Number
Cell Number*
E-mail*
example@example.com
Emergency Contact
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
Additional Authorized Pickup Adult

The registering Parent/Guardian or Authorized Pickup Adult must be the person picking up the child/children. Your child/children WILL NOT be released to anyone other than the authorized persons on this form.
Name

First NameLast Name
Phone Number
VACATION BIBLE SCHOOL LIABILITY WAIVER

I hereby acknowledge that my participation in the Vacation Bible School (VBS) event organized by Susanna Wesley UMC involves certain inherent risks and dangers. In consideration of being permitted to participate in VBS activities, including but not limited to games, crafts, and the use of a bounce house, I agree to the following:

1. Assumption of Risk: I understand that participating in VBS activities, including the use of a bounce house, involves inherent risks, for my child(ren) including but not limited to bodily injury, falls, collisions, and equipment malfunctions. I voluntarily assume all such risks and accept sole responsibility for any injury, death, or property damage I may sustain as a result of my participation.
2. Waiver and Release: I hereby waive, release, and discharge Susanna Wesley UMC, its directors, officers, employees, volunteers, and agents from any and all claims, liabilities, actions, damages, costs, or expenses of any kind arising out of or relating to my child(ren)'s participation in VBS activities, including those arising from the negligence or carelessness of the church, its staff, volunteers, or other participants.
3. Indemnification: I agree to indemnify and hold harmless Susanna Wesley UMC, its directors, officers, employees, volunteers, and agents from and against any and all claims brought by third parties arising from my child(ren)'s actions or conduct during my participation in VBS activities.
4. Photography Release: I grant permission to Susann Wesley UMC to take photographs and/or video recordings of my child(ren) during VBS activities and to use such materials for promotional purposes without compensation to me. If I do not wish for photographs/videos to be taken of my child, I agree that I have alerted the registration staff of this exemption.
5. Medical Treatment: In the event of injury or illness, I authorize Susanna Wesley UMC and its representatives to obtain necessary medical treatment for my child(ren) and I agree to be responsible for any costs incurred.
6. Safety Guidelines: I agree that my child(ren) will follow all safety guidelines, instructions, and rules provided by Susanna Wesley UMC and its staff or volunteers during VBS activities.

I have read this waiver of liability, fully understand its terms, and acknowledge that I am voluntarily giving up substantial legal rights, including the right to sue. I sign this document freely and without inducement.
Todays Date*

MonthDayYear
Date
Signature*

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VBS Registration

Children's Information

Parent/Guardian Information

Emergency Contact

Additional Authorized Pickup Adult