St. David's VBS Registration Form

Camper’s Name

First NameLast Name

Your Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Format: (000) 000-0000.

E-mail*

example@example.com

T-shirt Size*

Grade just completed*

Age*

Do you have friends attending VBS that you want in your crew?

Food Allergies or Specific Needs we should know about: *

Do you need aftercare until 3:00pm (there is an additional $25 fee)? *

Will you be the only person dropping off and picking up?*

Yes, it will be me every day.No (Please list them in emergency contacts)Other

Legalese:*

I confirm that my child is healthy and capable of participating in this event. I also confirm that my child is covered by medical insurance, or, if medical insurance is not available, I agree that I will be personally responsible for the costs of any medical treatment deemed necessary.I hereby release, relieve, indemnify, and hold harmless the employees and staff of St. David’s Episcopal Church from any and all liability for any injury, illness, or property damage associated with my child’s participation in this activity.In the event that my child should require medical treatment and I cannot be contacted immediately, or if contacting me is not feasible because of an emergency, I hereby give my consent to such treatment.I understand that photos or videos of my child and others may be taken during the event, and I hereby consent to the use of my child’s photo or likeness by St. David’s Episcopal Church in promotional materials.I acknowledge and confirm the information listed here and on my child’s application is true and accurate.I hereby give permission for my child to attend and participate in VBS, to take place at St. David’s Episcopal Church, 301 East 8th Street, Austin Texas 78701Other

Emergency Contacts:*

Rows	Full Name	Address	Contact Number
1
2

Signature*

Rez, St. James & St. David's VBS Registration Form