Magnified VBS Life Tabernacle Church

Magnified VBS Life Tabernacle Church

Life Tabernacle Church VBS
Parent Name

First NameLast Name
Birth Date

MonthDayYear
VBS Info

July 16,17,18| 6:00 pm- 8:30 pm | Ages 4-12 Year Old| 407 Bethel Rd Murray KY 42071|
Grade
VBS Child Info

(A separate form must be filled out for each child attending)
MaleFemale
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Name

First NameLast Name
Home Number
Format: (000) 000-0000.
Cell Number
Format: (000) 000-0000.
E-mail
example@example.com
Parent/Guardian Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Format: (000) 000-0000.
Alt. Phone Number
Format: (000) 000-0000.
Does the Child have any allergies, chronic illness, special diet,or medical conditions? If yes, please describe.
Emergency Information
Is the child prescribed an inhaler or any other medical device? If yes, please explain any instructions.
Signature

Clear
Date

MonthDayYear
Date
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by LTC during the selected VBS. In exchange for the acceptance of said child’s candidacy by LTC ., I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless LTC . and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of participating in VBS activities.
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.
YesNo
Should be Empty:

Magnified VBS Life Tabernacle Church

VBS Info

VBS Child Info