VBS Participant Registration (Elim 2026)

Participant's Name

First NameLast Name

Participant's Birthdate

Date

What grade will the participant enter in September 2026?

Please note one or two children with whom the participant would like to be grouped during VBS. If none, please type "None".

Please note any allergies or medical concerns of which we should be aware. If none, please type "None".

Please note any physical, emotional, mental, or behavioural concerns/limitations of which we should be aware. If none, please type "None".

Please note any medications the participant will have with him/her. If none, please type "None".

Participant's MCP number

Participant's Family Doctor (Name & Phone)

Participant's Address

Street Address

Street Address Line 2

CityProvincePostal CodeCountry

Participant's Home Church

Parent/Guardian Name

First NameLast Name

Parent/Guardian E-mail

example@example.com

Parent/Guardian Phone

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

Emergency Contact Name (someone other than the Parent/Guardian noted above)

First NameLast Name

Emergency Contact Phone

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

Authorized Pick-up Person (if different than Parent/Guardian and Emergency Contact)

First NameLast Name

Authorized Pick-up Person's Phone

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

Do you grant permission to Elim Pentecostal Tabernacle for the reasonable use (promotional and archival) of photographs/videos containing the participant?

CONFIDENTIALITY

Information gathered is confidential and is being gathered for the purposes of serving the participant while in the care of Elim Pentecostal Tabernacle's Children's Ministries programming. Any medical information collected serves to authorise Elim Pentecostal Tabernacle, and its staff and volunteers, to obtain medical assistance in emergencies.

MEDICAL TREATMENT AUTHORIZATION

The safety of the participant is our primary concern. Precautions will be taken for the participant's wellbeing and protection.

I, the above-named parent/guardian, authorise Elim Pentecostal personnel to sign a consent for medical treatment and to authorise a physician or hospital to procide medical assessment, treatment, or procedures for the participant in the case of an emergency.

I, the above-named parent/guardian, undertake and agree to indemnify and hold harmless Elim Pentecostal Tabernacle, the Pentecostal Assemblies of Newfoundland and Labrador, and its leaders, from and against any loss, damage, or injury suffered by the participant as a result of participating in Elim Pentecostal Tabernacle's Children's Ministries programming, and of any medical treatment authorized by Elim Pentecostal Tabernacle personnel. This consent and authorization is effective only when the participant is participating in, or traveling to, events sponsored by Elim Pentecostal Children's Ministries.

MAINTAINING OF INFORMATION

The Pentecostal Assemblies of Newfoundland and Labrador collects and retains personal information for the purpose of enrolling the participant in Elim Pentecostal Tabernacle's Children's Ministries programming. This information will be maintained indefinitely, as is required by our insurer and legal counsel. If you wish to limit the amount of information collected, or to view the participant's information, please contact us.

I, the above-named parent/guardian, have read, understood, and agree with the above-noted information.

Date

VBS Participant Registration (2026)

Friday (June 19/26) to Tuesday (June 23/26)