VBS@Garlow Line Registration Form

Location:
GARLOW LINE BAPTIST CHURCH
3207 Second Line Road, Hagersville, Ontario
(in front of the Iroquois Lacrosse Arena)

SAVE THE DATES:
- July 2-4, 2025 (Ages 5-8) - 9:00 to 11:30 AM
- July 7-11, 2025 (Ages 9-14) - 9:00 to 11:30 AM

The summer event will feature singing, bible stories,
VBS skits, a puppet show, the Wheelie Wacky Spinner,
memory verses, games, crafts, and a Hot Wheels and
RC Racing Contest with prizes to be given at
"The Winner's Corner" each day.

FOR MORE INFORMATION, CALL US AT 226-922-1203.

Child's Name

First NameLast Name

Birth Date

MonthDayYear

Grade

Gender

MaleFemale

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Information

Name

First NameLast Name

Home Number

Cell Number

E-mail

example@example.com

Emergency Information

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Alt. Phone Number

Does the athlete have any allergies, chronic illness, or medical conditions? If yes, please describe.

Is the athlete prescribed an inhaler? If yes, please explain any instructions.

Informed Consent and Acknowledgement

I approve my child’s participation in activities organized by Garlow Line Baptist Church during the summer event this July of 2025. I assume all risks related to these activities and release Garlow Line Baptist Church, its officers, agents, and representatives from any liability for injuries arising from travel, participation, or return from VBS sessions.

In case of injury, I waive all claims against Garlow Line Baptist Church, including coaches, affiliates, participants, sponsors, advertisers, and property owners. Sports activities, including running and other activities, carry inherent injury risks such as fractures, paralysis, or death.

Medical Release and Authorization

As Parent and/or Guardian of the named student, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor examination, treatment and immunizations for the named student. In the event of an emergency arising from serious illness, the need for major surgery, or significant accidental injury, I understand that the attending physician and the event director will make every attempt to contact me expeditiously. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to Garlow Line Baptist Church and its affiliates, including Directors, Coaches, and Team Parents, to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of the life and limb of the named minor child, in my absence.

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.

Vacation Bible School Registration

Student Information