Redeemer Church Pittsburgh - Vacation Bible School Registration

Vacation Bible School Registration

Redeemer Church Pittsburgh
This is the form to register SPROUTS ages 4-10 years old
Location

Redeemer Church

325 N Highland Ave,
Pittsburgh, PA 15206
Schedule

July 16-18
5:45 - 7:45 PM

Closing Picnic
Saturday, July 19
4:00 - 5:00 PM
For any questions, please contact Tim Lowrance at 412-514-5816 (text or phone call)
Child Registration*
Name(s) of Parent(s) or Guardian(s)*
Parent / Guardian Email*
example@example.com
Parent / Guardian Phone Number*
Parent/ Guardian Address*

Street Address

Street Address Line 2

CityState

Zip Code
Emergency Contact*

Child's emergency contact is the same as parent/guardianI would like to enter a different emergency contact
Emergency Contact Name*
Emergency Contact Relationship to Child (e.g. Grandparent, Nanny, Neighbor)*
Emergency Contact Phone Number*
Eligible pick-up person(s) - who can pick up the child in addition to the parent/guardian and emergency contact?
Consent to Participate
I, the undersigned parent or legal guardian, give permission for my child to attend and participate in all Vacation Bible School (VBS) activities hosted by Redeemer Church Pittsburgh.

Medical Authorization

In the event of an emergency and the child's designated emergency contact cannot be reached, I authorize Redeemer Church Pittsburgh staff or volunteers to administer first aid and seek emergency medical treatment for my child, including transportation to a medical vacility if necessary.
Please list any allergies, medical conditions, or medications:
Photo & Video Release*

I give permission for my child to be photographed or recorded during VBS for use in VBS promotion in the future.I do not give permission for my child to be photographed or recorded
Liability Release

I understand that Redeemer Church Pittsburgh will take reasonable precautions for the safety of all participants. I release the church, its staff, and volunteers from any liability for injury, illness, or loss that may occur during VBS activities.
Participating Child's Name(s)*
Parent / Guardian Name*
Parent / Guardian Signature*

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Vacation Bible School Registration

Consent to Participate