VBS 2026 CHILDREGISTRATION FORM

Date: June 29-July 3
Time: 9:00 am-12:15 pm
www.calvaryot.com

Child's Name

First NameLast Name

Select One:

DOB:

Date

Grade in the Fall *must be entering Kindergarten in the Fall

Parent: Mom:

Parent: Dad:

Email (please print clearly):

example@example.com

Address:

Street Address

Street Address Line 2

City

Postal / Zip Code

Parent Contact:

Format: (000) 000-0000.

Emergency Contact: Name

Phone:

Format: (000) 000-0000.

If you would like a shirt for your child, please choose a size from the options below. Please mark one.

Children Size:

Or Adult Sizes:

Parents please be aware your child will be photographed during the week of VBS. Photos will be used for CCOT's promotional purposes ONLY. Initial here

The following Releases are mandatory to participate in VBS and are put into place by our Insurance Company. Parents, please sign/initial below. Blank signatures will void registration.

I hereby release, forever discharge and agree to hold harmless, CCOT, its elders, directors, employees and volunteers, from all liability, claims, and/or demands for personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the above named child that occur during any activities. Furthermore, I hereby assume all risk of personal injury, sickness, death, damage and expense as a result of participation in these activities. The under signed further agrees to hold harmless and indemnify CCOT, its elders, directors, employees and volunteers, for any liability sustained by said church as the result. Initial here

I, ____________________________________, parent or legal guardian of the child listed on this form herein authorize the adult sponsor of CCOT to consent to any X-ray, examination, anesthetic, medical or surgical diagnosis or treatment, on the advice of any physician or surgeon licensed to practice in that state of treatment, when the need for such treatment is immediate, and when efforts to contact me are unsuccessful.

Signature:

Date:

Date

Personal Physician Name:

Phone:

Format: (000) 000-0000.

Insurance Company Name:

Policy #:

Please list any allergies, medical conditions, or safety concerns we should know about your child:

Is there a friend your child would like to be paired with for VBS? We will do our best to accommodate but we try to keep children of similar age ranges together:

VBS 2026 CHILD REGISTRATION FORM