Vacation Bible School Registration Form 2024 "It's a Wonder-full Life!"

Name

First NameLast Name

Date of Birth

Date

Email

example@example.com

Phone Number

Please enter a valid phone number.

Grade entering in fall

Tee Shirt Size

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contact Name

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.

If the above person cannot be reached, please list an additional Emergency Contact

First NameLast Name

Relationship

Phone Number

Please enter a valid phone number.

Any there any Allergies or Medical Conditions/ Medications that the staff should be aware of?

YesNo

Please give details, and list anything else you'd like the staff to be aware of:

I, undersigned, agree with the following statements:*

In the event of an injury or illness, I give permission to the leaders to secure necessary medical treatment, and I relieve them of any and all liability in such event, understanding that I will be contacted promptly if such a situation arises. I understand that the church may record the image, voice, or likeness of the applicants. I hereby give permission for St. Peter’s United Church of Christ to use images in conjunction with publicizing events without remuneration to me or my child(ren). Personal information is not released in any publicity materials without the expressed consent of the parent. This form remains in effect from July 15, 2024 - July 18, 2024 or until revoked by the parent or guardian. It is the parent’s responsibility to inform St. Peter’s United Church of Christ of any changes or additions.I, as parent/guardian of the child listed above, give my permission for him/her to accompany pastors, advisors, and/or recognized chaperones of St. Peter’s United Church of Christ on Church sponsored outings and activities. I understand there are dangers and risk of injury inherent in participating in these outings and activities, but still desire to allow the above named to participate in such activity. Therefore, the undersigned, for and in consideration of the opportunity to allow the participant to participate in outings and activities, and for other good and valuable consideration, does hereby forever release, quit and forever discharge St. Peter’s United Church of Christ, it pastors, advisors, employees, insurers, agents, servants, and recognized chaperones (hereafter referred to as “Released Parties”) from any and all claims, demands, rights and causes of action of any kind or arising out of any and all known and unknown, foreseen or unforeseen bodily and personal injuries, property damage or the consequence thereof, resulting from any accident, casualty or event involving the above named participant and arising out of participating in Church sponsored outings and activities. I UNDERSTAND THIS MEANS I AGREE NOT TO SUE ANY AND ALL OF THE RELEASED PARTIES FOR ANY INJURIES ORPROPERTY DAMAGE RESULTING TO THE ABOVE NAMED PARTICIPANT DURING OR IN CONNECTION WITH HIS OTHER PARTICIPATION IN CHURCH SPONSORED OUTINGS AND ACTIVITIES. I understand this Release does not waive liability for intentional reckless acts, as such claims cannot be waived, but do understand this Release waives claims of any other kind, specifically including claims for negligence, against the Released Parties. FURTHER AND BY WAY OF INDEMNITY, the undersigned hereby expressly understands and agrees to indemnify and hold harmless the Released Parties, their employees, agents, or insures, against any and all claims for damages, costs or expenses, incurred by the Released Parties, their employees, agents or insures, as a result of any accident or injury which might occur while the above named participant is participating in Church sponsored outings and activities and which may result from the negligence of the Release Parties, their employees, and agents, third parties or any combination there of. The undersigned further declares and represents that no promise, inducement or agreement not contained in this written agreement has been made to the undersigned and that this Release contains the entire agreement between the parties and the terms of the Release contractual and not mere recital. The undersigned further acknowledges the opportunity to negotiate this Release with an authorized member of St. Peter’s United Church of Christ.

I am interested in helping:

I am interested in helping with Vacation Bible SchoolI am interested in serving on our Church's Christian Education Ministry TeamI am not able to help at this time

Please type your full name here, indicating that you agree to all of the above document*

First NameLast Name

The cost of VBS is $15 per person, to cover the cost of the shirts, food, and crafts. Please Visit the website below, and choose "Give to Christian Education" from the dropdown menu when you pay.

https://stpetersucc.breezechms.com/give/online

Date

St. Peter's United Church of Christ Vacation Bible School Registration Form