2025 VBS Friday 5/30 5:30p-8:30p & Saturday 5/31 10a-4p YEE- HAW SMLC Waiver Form

2025 VBS Friday 5/30 5:30p-8:30p (Friday Family Dinner 6:30p) & Saturday 5/31 10a-4p YEE- HAW SMLC Waiver Form

Please fill out this form to complete the VBS waiver.
Participant Name

First NameLast Name
Parent/Guardian Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Participant Age
Parent/Guardian Email
example@example.com
Parent/Guardian Phone
Please enter a valid phone number.
Emergency Contact Name

First NameLast Name
Emergency Contact Phone
Please enter a valid phone number.
Please list any allergies or medical conditions
I consent to my child's participation in the VBS program.

YesNo
I authorize the VBS staff to seek emergency medical treatment for my child if necessary.

YesNo
St. Michael Lutheran Church has my permission to use my or my child’s photograph publicly to promote the church and/or VBS. I understand that the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of use.

YesNo
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.

Signature will be required at VBS drop off.

______________________________________________

Date:______________________
Should be Empty:

2025 VBS Friday 5/30 5:30p-8:30p (Friday Family Dinner 6:30p) & Saturday 5/31 10a-4p YEE- HAW SMLC Waiver Form