Young Climbers / Renew Church VBS Registration Form

Young Climbers / Renew Church VBS Registration Form

Please fill out your details to register for VBS.
Participant's Full Name

First NameLast Name
Participant's Date of Birth

MonthDayYear
Date
Health Care Card Number
Medications
Allergies
Support Needs
Does the participant have any allergies or medical conditions?
Child Shirt Size
Parent/Guardian Full Name

First NameLast Name
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email Address
example@example.com
Parent/Guardian Full Name

First NameLast Name
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email Address
example@example.com
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Authorized Pick up Full Name

First NameLast Name
Authorized Pick up Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Authorized Pick up Full Name

First NameLast Name
Authorized Pick up Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Do you have a home church?
Permission to participate in VBS activities
Medical Authorization
Medical Authorization: In the event of a medical situation, we will contact the parents and or the emergency contact, if we are unable to reach the parent or emergency contact. I/we, the parent(s) or guardian(s) named above, authorize Young Climbers Childcare staff to consent for medical treatment, and to authorize any physician or hospital to provide medical assessment, treatment, or procedures for the participant named above.
Photo Authorization
Photo Authorization: I/we, the parent(s) or guardian(s) named above, authorize Young Climbers Childcare staff to take videos and pictures during the VBS Camp. These videos and pictures will be used on the Young Climbers, and or Renew Church Website and marketing materials. I understand they retain the sole right to use the photos & videos.
Acknowledgement & Assumption of Risk
Acknowledgement & Assumption of Risk: I/we, the parent(s) or guardian(s) named above, understand that sporting activities may result in injury to my child. It is entirely my choice to allow my child to take part in this activity, and therefore, I accept and assume responsibility for any possible risk to my child by participating in VBS Camp.
Release and Waiver of Liability:
Release and Waiver of Liability: I/we, the parent(s) or guardian(s) named above, hereby acknowledge and release Renew Church, Young Climbers Childcare, employees, insurers from any and all claims, liabilities, or legal costs, damages, brought by myself, my children, arising in any way from participation by my child in the VBS camp.
Should be Empty:

Young Climbers / Renew Church VBS Registration Form

Medical Authorization

Photo Authorization

Acknowledgement & Assumption of Risk

Release and Waiver of Liability: