VBS 2026 - Emerald Crossing

Parent/Guardian Name*

First NameLast Name

Email

example@example.com

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Parent/Guardian Name

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Child's Name - 1*

First NameLast Name

Child's 1 - Age or Grade Just Completed*

Child 1 - T shirt size*

Child's Name-2

First NameLast Name

Child 2 - Age or Grade Just Completed

Child 2 - T shirt size

Child's Name-3

First NameLast Name

Child 3 - Age or Grade Just Completed

Child 3 - T shirt size

Child's Name-4

First NameLast Name

Child 4 - Age or Grade Just Completed

Child 4 - T shirt size

Child's Name-5

First NameLast Name

Child 5- Age or Grade Just Completed

Child 5 - T shirt size

In consideration of your accepting me or my child for participation in VBS I hereby, for myself, my heirs, executors, and administrators, waive and release any and all rights and claims for damages that I may have against Black Oak Heights Baptist Church and its agents, employees, representatives, successors and assigns for any and all injuries suffered by myself or my child that arise out of the above named activity participated in at Black Oak Heights Baptist Church. I warrant that I have the right to authorize the foregoing and do hereby agree to hold Black Oak Heights Baptist Church harmless of and from any and all liability of whatever nature which may rise out or result from such participation. For the consideration stated above, I further agree that in the event that my child or I should make any claim against the church for damaged arising out of the above named activity, I will personally indemnify, defend, and hold harmless the church and its agents, employees, representatives, successors, and assigns against any and all loss and damage occasioned thereby, including attorney's fees. I have read and understand this agreement and have willingly placed my signature below as evidence of my acceptance of all the conditions contained herein.*

I agreeI do not agree

By signing below, I hereby give my full consent to BLACK OAK HEIGHTS BAPTIST CHURCH, a STATE nonprofit corporation, to record, by writing, by video, photographic, or audio recording device, or by any other analog or digital means, the actions, physical likeness, biographical information, and/or voice of me and/or any person of whom I am the parent or legal guardian, including minor children, for social media or the church website. I, on behalf of all participants, hereby release and discharge and agree to hold harmless BLACK OAK HEIGHTS BAPTIST CHURCH, its directors, officers, employees, volunteers, and independent contractors, from any and all claims or damages, including but not limited to defamation or violation of rights of privacy or publicity, arising from or associated with the recording or use of the recordings. This release shall be construed, interpreted and governed in accordance with the laws of the State of Tennessee, and should any provision of this release be determined invalid, such invalidity does not affect any of the remaining provisions. I am of full age and have the right to contract in my own name and for each Participant.*

I agreeI do not agree

Name*

First NameLast Name

Signature*

Date*

Date