VBS Waiver Form July 17th - 20th
Please fill out this form to complete the VBS waiver & Registration. VBS times 6:00 pm meal. 6:30 - 8:30 pm program
Participant Name
First Name
Last Name
Parent/Guardian Name
First Name
Last Name
Participant Age
Parent/Guardian Email
example@example.com
Parent/Guardian Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Name
First Name
Last Name
Emergency Contact Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Please list any allergies or medical conditions
I consent to my child's participation in the VBS program.
Yes
No
I authorize the VBS staff to seek emergency medical treatment for my child if necessary.
Yes
No
Hospital Choice
Saint Mary's or Athens Regional
Write in Hospital Choice.
By signing this form, I agree to release and hold harmless the VBS program, staff, and volunteers from any claims or liability arising from my child's participation.
Continue
Continue
Should be Empty: