Vacation Bible School Registration

Vacation Bible School Registration

July 7 - 11, 2025 | 6:00pm - 8:00pm

Child Information
Child's Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade Completed
Gender*

MaleFemale
Does the child have any allergies and/or medical conditions? If yes, please describe. If no, enter N/A*

Parent/Legal Guardian Information
Parent/Legal Guardian Name*

First NameLast Name
Home Number
Cell Number*
E-mail*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
(1) Authorized Person for Pick-Up*

First NameLast Name
(1) Authorized Person Phone Number*
Please enter a valid phone number.
(1) Relationship to Child*
(2) Authorized Person for Pick-up

First NameLast Name
(2) Authorized Person Phone Number
Please enter a valid phone number.
(2) Relationship to Child
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship to Child*
Phone Number*
Emergency Contact Phone number

Declarations
Informed Consent and Acknowledgement

I hereby assume all risk, known or unknown, for the child registered on this form, in connection with their attendance and participation in Vacation Bible School (VBS) at Hamilton Seventh-day Adventist Church. I acknowledge that participation in VBS at Hamilton Seventh-day Adventist Church is voluntary and therefore I FULLY RELEASE and discharge Hamilton Seventh-day Adventist Church, its pastors, elders, staff, and volunteers from any and all liability in connection with any activities carried on at Hamilton Seventh-day Adventist Church in the VBS program.
Informed Consent and Acknowledgement | Enter your initials here:*
Medical Release Authorization

In the event of an emergency, I understand that all will be done to contact me and/or the emergency contact named above. I give full permission to a representative of Hamilton Seventh-day Adventist Church to seek medical attention in my absence for the child registered on this form. I also release the Hamilton Seventh-day Adventist Church from all liability in case of accident or illness.
Medical Release Authorization | Enter your initials here:*
Photography/Videography Consent and Acknowledgement

I further acknowledge that the registered child, as a participant in VBS at Hamilton Seventh-day Adventist Church, may be photographed or captured on video during the VBS program and activities. I hereby grant full permission to Hamilton Seventh-day Adventist Church to use photographs and/or videos of the child registered on this form during the VBS program and for church-related purposes, including but not limited to promotional materials, website, social media and other publications.
Photography/Videography Consent and Acknowledgement | Enter initials here:*
Consents 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*

MonthDayYear
Date
Signature*

Powered by Jotform SignClear
Should be Empty:

Vacation Bible School Registration

Medical Release Authorization