VBS Child Registration

VBS Child Registration
Child Information

Please submit one form per child
Child Name*

First NameLast Name
Sex*

MaleFemale
Current School Grade
Current School Grade*
Date of Birth*

MonthDayYear
Age:
Allergies or Other Medical Conditions:*

PARENT/GUARDIAN INFORMATION
Parent/Guardian Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityProvince

Postal Code
Home Phone Number
Cell Phone Number*
E-mail*
example@example.com
Do you have legal custody of the child who is being registered?*

YesNo
Home Church (if applicable)
Emergency Contact (other than the parent above)

In the case that we are unable to reach you in an emergency, please provide the name and number of someone we can contact (other than the parent above).
Emergency Contact Name*

First NameLast Name
Emergency Contact Number*

Application Consent
I understand and acknowledge the following:

Emergency Contact Information: I have provided accurate emergency contact information, including my contact number, an alternate contact person, and their contact details. In case of any emergency, I authorize the camp staff to contact me or the designated alternate contact.
Medical Authorization: I authorize the camp staff to seek and obtain necessary medical treatment for my child/ward in the event of illness, injury, or any other medical emergency. I understand that the camp staff will make every effort to contact me or the emergency contact person before seeking medical treatment, but they may proceed with necessary medical care if deemed urgent.
Rules and Expectations: I have reviewed and discussed with my child/ward the rules, expectations, and code of conduct for VBS. I understand that my child/ward is expected to adhere to these guidelines throughout the camp duration.
Photo and Video Release: I grant permission for photographs and videos of my child/ward to be taken during the camp for promotional, educational, and archival purposes by West Deer Bible Church. I understand that these images may be used in printed materials, online media, and presentations related to the Church.
Liability Release: I release West Deer Bible Church, its staff, volunteers, and affiliates from any liability for injuries, accidents, or loss of personal property that may occur during the Church Camp.
By signing below, I confirm that I have read, understood, and agree to the terms and conditions outlined in this consent form. I hereby give my permission for my child/ward to participate in the Church Camp and engage in all planned activities.
Parent/Guardian Name:

First NameLast Name
Date

MonthDayYear
Date
Signature

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VBS Child Registration

Child Information

PARENT/GUARDIAN INFORMATION

Emergency Contact (other than the parent above)

Application Consent