VBS Registration Form for Rocky Hill Baptist Church

VBS Registration Form

Ages 5 - Completed 5th grade
Name Tag (Staff Use Only)
Group:
Number:
CHILD'S INFORMATION
NAME:*
GENDER: MALE/FEMALE*
AGE:*
CHILD'S BIRTH DATE:*

MonthDayYear
Date
LAST GRADE COMPLETED IN SCHOOL:*
WILL YOUR CHILD BE EATING DINNER AT 5:30 ON MONDAY-THURSDAY?*
HOW DID YOU HEAR ABOUT VBS AT RHBC?
PARENT/GUARDIAN NAME:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
PHONE (REQUIRED):*
Format: (000) 000-0000.
(WATCH FOR EMAILS WITH MENU AND OTHER UPDATES)
CHILD'S MEDICAL INFORMATION
CHECK HERE IF CHILD IS PRONE TO PHOTOSENSITIVITY
MEDICAL OR OTHER INFORMATION WE NEED TO KNOW, PLEASE INCLUDE ANY FOOD ALLERGIES:
EMERGENCY CONTACTS:
CONTACT 1:
PHONE:
Format: (000) 000-0000.
CONTACT 2:
PHONE:
Format: (000) 000-0000.
DISMISSAL INFORMATION (8:30PM) WHO MAY PICK UP YOUR CHILD:
NAME*
PHONE:*
Format: (000) 000-0000.
NAME
PHONE:
Format: (000) 000-0000.
OTHER INFORMATION
Thank you for bringing your child to VBS at Rocky Hill Baptist Church! We strive to make our church campus a safe environment for kids to come and learn about Jesus Christ. A few important things you may need to know: 1) We will be taking pictures during VBS. We may use these pictures in slideshows, church publications, on the website, for event promotion, etc. 2) In the event of an emergency, medical and/or dental services will be sought (including x-rays, surgeries, examinations, hospital care, etc.). The undersigned agrees to pay all costs and expenses incurred in connection with such medical and/or dental services rendered to any child named on this registration form. We are excited to serve your family during VBS!

Rocky Hill Baptist Church

Inflatable Water Slide Waiver Form

hereby voluntarily allow my child to participate in playing on the inflatable water slide provided by Rocky Hill Baptist Church (“RHBC” hereinafter).

I hereby confirm that my child is in good physical condition and does not suffer from any disabilities or physical conditions that places me or others at risk or otherwise should prohibit their participation in this event.

I am aware that the use of the water slide involves inherent risks, including but not limited to injury from falling, colliding, or improper use, and I voluntarily assume all risks related to my child’s participation.

In consideration of my child being permitted to use the water slide , I hereby release, waive, discharge, and covenant not to sue RHBC, its members, volunteers, and representatives from any and all claims, liabilities, damages, or expenses, including but not limited to personal injury or property damage, arising from or related to my use of the water slide, except where such injury or damage is caused by the gross negligence or willful misconduct of RHBC.

In the event of an injury or medical emergency, I authorize RHBC to seek medical treatment or assistance on my behalf or on behalf of any child under my care.

I have read this waiver and fully understand its contents. I acknowledge that by signing this waiver, I am giving up substantial legal rights, including the right to sue RHBC.
SIGNATURE (By signing your name below, you affirm that all provided information is correct, and you agree to RHBC's policies listed under "Other Information"):*

Clear
DATE:*

MonthDayYear
Date
Should be Empty:

VBS Registration Form

CHILD'S INFORMATION

CHILD'S MEDICAL INFORMATION

EMERGENCY CONTACTS:

DISMISSAL INFORMATION (8:30PM) WHO MAY PICK UP YOUR CHILD:

OTHER INFORMATION

Inflatable Water Slide Waiver Form