KIDS VBS Registration Form

Child's Name*

First NameLast Name

Birth Date*

MonthDayYear

Grade*

Gender*

MaleFemale

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

Guardian’s Family Group Leader*

Emergency Information

Emergency Contact's Name*

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.*

Please let us know if your child has any other special needs or considerations so we are able to best accommodate them.

If your youth has a fever, headache, or minor injury, do you consent to providing them medication without calling you first?*

YesNo

I understand and appreciate that Freedom International Christian Training Center's event, VBS "Shout" (hereafter referred to as the Event), in which I (or my child/children) will participate, involves inherent dangers, hazards, and risks which may be unknown to me. I further understand that there are risks and dangers associated with the Event that can result in minor or serious injuries include, but are not limited to: unknown facility hazards or defects; and careless, erratic, or negligent acts by other attendees of the Event.

I understand the risks and dangers of personal injury, disability, and/or death to me (or my child/children) as a result of participation in the Event. I acknowledge that I am solely responsible for determining my (or my child's/children's) suitability to participate in the Event. I agree to assume the full risk of injuries that may be sustained by myself (or my child/children) as a result of participating in the Event at Freedom International Christian Training Center.

I further acknowledge that parts of the Event will occur over public roads and facilities open to the public and upon which hazards are to be expected. I acknowledge and represent that I (or my child/children) am in the good physical and mental health necessary to participate in the Event, as some of the activities associated with this event require strenuous exercise and various degrees of skill. I (or my child/children) share(s) responsibility for my (his/her/their) safety and will follow instructions, make reasonable decisions, and act responsibly.

Freedom International Christian Training Center cannot ensure my (or my child's/children's) safety. I choose to (or allow my child/children to) voluntarily participate in the Event, despite all risks. I have explained these risks and dangers to my child/children attending the Event, and his/her/their participation is both willing and voluntary. Freedom International Christian Training Center will have no responsibility, liability, or consequence pursuant to my or my child's/children's action(s). I (and/or my child/children) have adequate health insurance necessary to provide for and pay any and all medical costs that may arise as a result of my (and/or my child's/children's) participation in the Event. I assume all inherent and other risks and accept responsibility for any property damage and loss and for any personal injury, illness, disability, emotional distress, and death that I (and/or my child/children) may suffer that arises out of my (or his/her/their) participation in the Event, whether described in this document or not.

I understand that my execution of this Child Assumption of Risk, Waiver and Indemnity Agreement is a prerequisite for my (or my child’s/children’s) participation in the Event. In consideration of Freedom International Christian Training Center thereof, I agree to the following:

Waiver and Release:
I, (and/or on behalf of my child/children), agree to forever release and discharge Freedom International Christian Training Center from and agree not to sue Freedom International Christian Training Center for any and all liability or claims I (and/or my child/children) may have for any property damage and loss, personal injury, emotional distress, illness, disability, and death, related to my (or my child's/children's) participation in the Event, the use of any equipment or facilities in connection therewith. This release is for any claim, demand, and action of every name and nature, including breach of contract, fraud, or any other type of suit, and includes personal injury and property losses alleged to be caused by the negligence and/or gross negligence of Freedom International Christian Training Center to the fullest extent permitted by law.

Indemnity:
I agree to defend, indemnify (meaning to pay or reimburse any amount required to be paid, including without limitation, attorney's fees, judgment costs, and investigation costs), and hold Freedom International Christian Training Center harmless from all claims, causes of action, liability, losses, or damages for any property damage, property loss or theft, personal injury, disability, death, or other loss brought by or on behalf of me, my child, a family member, my estate, another participant or spectator, or any other person arising from or relating to my (or my child's/children's) participation in the Event, including claims that Freedom International Christian Training Center was negligent.

Photo Waiver:
Freedom International Christian Training Center may take and use photographs, video, film, and other images of me (or my child/children) participating in or observing the Event. I waive any right of privacy, publicity, compensation, copyright, or other rights to those images, and I consent to Freedom International Christian Training Center using those images for promotional purposes.

Clarifying Clauses:
1. I am competent and have read this Agreement. I understand its contents, and I sign it voluntarily. I understand that I have given up substantial rights by signing it, including my rights and the right of my child/children to sue for damages, understand that I and/or my child/children can choose not to participate in the Event, and have signed it freely and without any inducement or assurance of any nature. I intend by this Agreement to assume all risks, waive all rights to sue, and release all liabilities and claims, and indemnify Freedom International Christian Training Center for any claims arising from my (or my child's/children's) participation in the Event.
2. I understand that this Agreement has no expiration date and remains in effect at all times that I am (or my child/children) observing or participating in the Event and will be binding on me, my family members, heirs, assigns, executors, representatives, and estate.
3. I understand that this Agreement is intended to be as broad and inclusive as is permitted by the laws of the State of California . I agree that if any portion of this Agreement is held to be invalid, the balance notwithstanding, shall continue in full force and effect.
4. This Agreement supersedes any and all previous oral or written promises or agreements regarding the contents herein. I understand that this is the entire agreement between Freedom International Christian Training Center and me and that it cannot be modified or changed in any way by representations or statements by any agent or employee of Freedom International Christian Training Center.

I agree to all of the above terms & conditions.

Assumption of Risk, Waiver & Indemnity E-Signature (Parent/Guardian type in full name) *

I understand that in the event my child/children require(s) medical or dental treatment during VBS "Shout" 2024, reasonable efforts will be made to contact me.

In the event that I (or my child/children) become incapacitated during VBS "Shout" 2024, I hereby authorize Freedom International Christian Training Center to consent to X-ray, examination, anesthetic, medical, dental, or surgical diagnosis, treatment, and/or hospital care deemed necessary or advisable by a licensed physician. It is understood that this authorization is given in advance of any specific diagnosis, treatment, or hospital care being required. It is given to provide authority and power on the part of Freedom International Christian Training Center to give specific consent to the diagnosis, treatment, and/or hospital care, which, in the best judgment of a licensed physician, is deemed necessary.

I authorize the use of first aid by Freedom International Christian Training Center if Freedom International Christian Training Center deems it is needed.

I authorize the use of CPR if Freedom International Christian Training Center deems it is needed.

I authorize Freedom International Christian Training Center to secure emergency medical care and transport if deemed necessary by Freedom International Christian Training Center.

I agree to assume all costs of emergency care and transportation.

To the best of my knowledge, I have listed above all of my (or my child's/children's) allergies, including food and medical allergies, medications being taken, medical problems, and other pertinent information. My child/children has permission to participate in all activities associated with FCY Camp 2024 except as noted by me in the space above.

I CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A CONTRACT, AND I SIGN IT OF MY OWN FREE WILL.

I agree to all of the above terms and conditions

Assumption of Risk, Waiver & Indemnity E-Signature (Parent/Guardian type in full name)*

CODE OF CONDUCT

While attending VBS Shout 2024, I will:

RESPECT PEOPLE: I can honor God with how I treat others. I’ll show respect to everyone around me, including staff, leaders, volunteers, and other children. This includes what I do and what I say. I’ll listen when others are speaking, and I’ll show gratitude for what others do for me.
RESPECT PROPERTY: Being allowed to use what belongs to others is a privilege. I’ll take care of all facilities and properties. I will leave every location better than I found it.
RESPECT MYSELF: I am responsible for the decisions I make. I’ll be a positive role model to others around me, obey all rules and instructions, and make wise choices.
While attending VBS Shout 2024, I won’t:

BE A BULLY: Being mean or hurtful to others is wrong — everyone should feel safe and welcome wherever I am. I won’t intimidate anyone, hurt anyone through my actions or words, be aggressive or violent, or make anyone feel left out. If I see bullying, I’ll report it immediately.
BE NEGATIVE: Our words should be used to build others up — not tear them down. I won’t gossip or talk about other people in a mean way, or say anything that could hurt someone.
BE CARELESS: Going places and doing activities is fun, but it comes with responsibility. I’ll make sure I don’t put myself or others in danger, or take risks that could get someone hurt.

RULES

Parents/Guardian, if your child breaks any of these rules, you may be called to pick him/her up from wherever he/she is at that time. There will be no refunds if this happens.

Listen: Obey leaders and staff at all times.
Bullying: Bullying will not be tolerated. This includes any attempt to harm, intimidate, isolate, or force someone to do something.
Substances: No drugs, tobacco, vapes, Juuls, or alcohol. Bags will be checked at initial check-in. (If youth take any kind of prescription medication, make sure it is packed in a clear bag with a doctor’s note explaining why the child needs that medication.)
Clothing: No inappropriate clothing. This includes clothing with logos, phrases, or graphics that contain profanity or sexual/offensive content. Shorts, shirts, and bathing suits that are revealing are also not allowed.
Weapons: No weapons (including pocket knives) are permitted.
Contact: No inappropriate displays of affection with other children. (This includes but is not limited to kissing or any kind of sexual activity.)
Behavior: Stealing, lying, fighting, and other disruptive behavior will not be tolerated.
YOUTH: By attending VBS Shout 2024, you are acknowledging that you understand the VBS Shout 2024 Code of Conduct and Rules. If you break any of these rules, a parent or guardian will be called to pick you up, and you will not attend the rest of VBS Shout 2024.

PARENTS: By signing this form, you acknowledge that your child understands the VBS Shout 2024 Code of Conduct and Rules and that you are responsible for picking him/her up if any rules are broken.

I agree to all of the above terms & conditions.

Child Code of Conduct E-Signature (type in full name) *

Parent/Guardian Code of Conduct E-Signature (type in full name)*

We will have a team assigned to secure the premises during VBS Shout
There are live cameras around every area of our building besides restrooms.
Cameras will be in full effect during all hours of VBS.

I agree to all of the above terms & conditions.

Parent/Guardian Security Plan E-Signature (type your full name) *

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*