VBS Registration Form
Child's Name
*
First Name
Last Name
Age
*
Please Select
5
6
7
8
9
10
11
12
Other
Date of Birth
*
-
Month
-
Day
Year
Date
Medical Information, Allergies, Special Needs
*
Parent/Guardian
Full Name
*
First Name
Last Name
Primary Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Secondary Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Alternate Emergency Contact
*
First Name
Last Name
Relationship
*
Phone Number
*
Format: (000) 000-0000.
Do you have a regular church home?
*
Yes
No
If yes, Church you are currently attending
I am a guest of:
First Name
Last Name
Dismissal Information
Who is allowed to retrieve this child at the end of VBS?
*
First Name
Last Name
Are there custody issues involving this child?
*
Yes
No
If yes, please clarify.
Do we have permission to photograph your child?
*
Yes
No
May we use your Child's photograph in church publications for the purpose of promotion?
*
Yes
No
Photo Disclaimer
Having been made aware of the activities the student will be doing, I hereby consent to the student’s participation in the Glendale Christian Church VBS (Vacation Bible School). I voluntarily release and forever discharge Glendale Christian Church and all VBS Volunteers from any and all liability, claims, actions or rights of action which are in any way related to the student’s participation in the event’s activities. I agree to indemnify and hold Glendale Christian Church and the VBS Volunteers harmless from any and all costs or damages, including attorney fees, incurred in connection with the student’s participation in event activities. I further agree not to sue, assert or otherwise maintain any claim or cause of action against Glendale Christian Church or the VBS Volunteers arising from the student’s participation in Glendale Christian Church's Vacation Bible School. In case of emergency, I understand that every effort will be made to contact parents or guardians of minor students. However, if parents or guardians cannot be reached, I hereby give Glendale Christian Church and any acting agent thereof permission to act on my behalf in seeking and administering medical treatment in the event that such treatment is deemed necessary or advisable for the student’s health, safety, and welfare. I release Glendale Christian Church and all VBS Volunteers from liability in acting on my behalf in this regard and rendering such medical treatment. I assume the risk and financial responsibility for any injury or illness resulting from the student’s participation in event activities.
Parent/Guardian Signature
*
First Name
Last Name
Register for VBS
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