VBS Registration and Waiver Form
Please fill out this form to complete the VBS registration and waiver.
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Participant Name
First Name
Last Name
Parent/Guardian Name
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First Name
Last Name
Participant Age
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Last School Grade Completed (optional)
Home Church (optional)
Parent/Guardian Email
*
example@example.com
Parent/Guardian Phone
*
Please enter a valid phone number.
Emergency Contact Name
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First Name
Last Name
Emergency Contact Phone
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Please enter a valid phone number.
Please list any allergies or medical conditions
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I give permission to my/our child to attend the Vacation Bible School at Immanuel Christian Reformed Church at 8302 Normandy Ave. Burbank, IL 60459 on June 23 – June 27, 2025. This consent form gives permission to seek whatever medical attention is deemed necessary, and releases Immanuel Christian Reformed Church and its staff and volunteers of any liability against personal losses of named child. I/We the undersigned have legal custody of the child named below, and give our consent for him/her to attend events being organized by Immanuel Christian Reformed Church.
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Yes
No
I/We understand that there are inherent risks involved in any ministry or athletic event, and I/We hereby release Immanuel Christian Reformed Church, its pastors, employees, agents and volunteer workers from any and all liability for any injury, loss or damage to person or property that may occur during the course of my/our child’s involvement. In the event that my/our child is injured and requires the attention of a doctor.
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Yes
No
In the event that my/our child is injured and requires the attention of a doctor, I/We consent to any reasonable medical treatment as deemed necessary by a licensed physician.
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Yes
No
In the event treatment is required from a physician and/or hospital personnel designated by Immanuel Christian Reformed Church, I/We agree to hold such person free and harmless of any claims, demands, or suits for damages arising from the giving of such consent.
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Yes
No
I/We also acknowledge that we will be ultimately responsible for the cost of any medical care should the cost of that medical care not be reimbursed by the health insurance provider. Further, I/We affirm that the information provided on Immanuel Christian Reformed Church Vacation Bible School registration form is accurate at this date for the student(s) named below.
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Yes
No
I/We also agree to bring my/our child home at my/our expense should they become ill or if deemed necessary by the volunteers at the VBS for Immanuel Christian Reformed Church.
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Yes
No
I/We agree to apply sunscreen to my/our child before arriving at Immanuel Christian Reformed Church Vacation Bible School. I/We release Immanuel Christian Reformed Church, of all liability for sunburns that may occur due to outdoor activities during Vacation Bible School.
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Yes
No
I/We release Immanuel Christian Reformed Church to utilize pictures or videos taken for the following purposes of printed materials to include brochures and bulletins, web site, video, slide or PowerPoint (or similar) usage.
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Yes
No
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.
Date
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Month
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Day
Year
Date
Submit
Submit
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