Clone of Winter VBS 2025 Registration Form

Immanuel Baptist Church - Winter VBS 2025 Consent & Release Form:

(After submitting this form for your first child there will be instructions on how to register additional children)

Childs Name*

First NameLast Name

Child's Age*

Parent or Guardian Name*

First NameLast Name

Parent/Guardian Phone*

Parent Email*

example@example.com

Name Of Pick Up Adult*

First NameLast Name

Phone # for Adult Picking Up*

Allergies if any

Child's Medical Conditions We Should Be Aware Of

I Do Not Wish My Child To Participate In The Following Activities

If applicable; please enter any and all individual activities you would not like your child participating in.

I, the undersigned parent or guardian, hereby consent to my child, {childsName}, participating in the VBS sponsored by Immanuel Baptist Church, [Kenai, AK], January 2022, and in activities connected with the VBS. If my child has medical conditions that may be relevant to a physician in the event of an emergency, I have listed them below. I understand that An Adult will be transporting my child to and from the VBS on behalfImmanuel Baptist Church and hereby give my permission for my child to ride in this provided transportation.

In the event an emergency occurs, I may be reached at the telephone number listed below. If I cannot be reached, I hereby authorize Immanuel Baptist Church Volunteers to make emergency medical decisions for my child. If there are any activities I do not want my child to be involved in, I have listed them below.

I UNDERSTAND AND HEREBY AGREE TO ASSUME ALL OF THE RISKS WHICH MAY BE ENCOUNTERED ON SAID TRIP AND DURING SAID VBS, INCLUDING ACTIVITIES PRELIMINARY AND SUBSEQUENT THERE TO. I do hereby agree to release and hold Immanuel Baptist Church and its agents employees, and volunteers harmless from any and all liability, actions, causes of actions, claims, expenses, and damages on account of injury to my child or property which I now have or which may arise in the future in connection with the church camp or participation in any other associated activities.

I expressly agree that this release, waiver, and indemnity agreement is intended to be broad and inclusive as permitted by the law of the State of Alaska and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. This release contains the entire agreement between the parties hereto and the terms of this release are contractual and not a mere recital.

I further state that I HAVE CAREFULLY READ THE FOREGOING RELEASE AND KNOW THE CONTENTS THEREOF AND I SIGN THIS RELEASES MY OWN FREE ACT. This is a legally binding agreement that I have read and understand.