Clone of 2025 Vacation Bible School Registration

Registration Form
If you are registering more than 1 child all information must be completed for each child before proceeding to the next page.
Child's Name:

First NameLast Name
Age:
Special Needs / Allergies / Concerns: Type NA or No if no special needs or concerns.
Child's Name:

First NameLast Name
Age:
Special Needs / Allergies / Concerns: Type NA or No if no special needs or concerns.
Child's Name:

First NameLast Name
Age:
Special Needs / Allergies / Concerns: Type NA or No if no special needs or concerns.
Child's Name:

First NameLast Name
Age:
Special Needs / Allergies / Concerns: Type NA or No if no special needs or concerns.
Child's Name:

First NameLast Name
Age:
Special Needs / Allergies / Concerns: Type NA or No if no special needs or concerns.
Parent/Guardian:

First NameLast Name
Cell Phone:
Format: (000) 000-0000.
Who is Picking up Child:
Who is Picking up Child:
Anyone not allowed to pick-up child: NA if not applicable.
E-mail:
Photo and Video Release

Emergency Medical Authorization

2025 VBS NCWC INC.
Child's Name

First NameLast Name
Child's Name

First NameLast Name
Child's Name

First NameLast Name
Child's Name

First NameLast Name
Child's Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
Legal Guardian's Name

First NameLast Name
Relationship to Child
Phone Number
Format: (000) 000-0000.
Legal Guardian 2 Name

First NameLast Name
Relationship to Child
Phone Number
Format: (000) 000-0000.
Emergency Contact's Name

First NameLast Name
Relationship to Child
Phone Number
Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState

Zip Code
Emergency Contact's Name

First NameLast Name
Relationship to Child
Phone Number
Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState

Zip Code
Part 1-To Grant Consent

I hereby give consent for the following medical care providers and local hospital to be called:
Consent Intent.
Doctor
Doctor
Doctor's Number
Format: (000) 000-0000.
Doctor's Number
Format: (000) 000-0000.
Dentist
Dentist
Dentist's Number
Format: (000) 000-0000.
Dentist's Number
Format: (000) 000-0000.
Local Hospital
Emergency Room Number
Format: (000) 000-0000.
In the event reasonable attempts to contact me have been unsuccessful, I hereby give my consent
for: (1) the administration of any treatment deemed necessary by above-named doctor, or, in the
event the designated preferred practitioner is not available, by another licensed physician or dentist;
and (2) the transfer of the child to any hospital reasonably accessible. This authorization does not
cover major surgery unless the medical opinions of two other licensed physicians or dentists,
concurring in the necessity for such surgery, are obtained prior to the performance of such surgery.
Facts concerning the child's medical history including allergies, medications being taken, and any physical impairments to which a physician should be alerted:
Instruction for refusal
Signature
Date

MonthDayYear
Date
Parental Consent

I hereby consent to let my child(ren) participate in the 2026 Vacation Bible School! It is understood that every precaution will be taken for the safety and well-being of my child(ren). In the unlikely event of accident, injury, or sickness, New Covenant Worship Center, Inc. (Jackson, Ohio, USA), its staff, and its volunteers are hereby released from any liability.
Parent's Name

First NameLast Name
Date:

MonthDayYear
By submitting this form, I give consent to New Covenant Worship Center, Inc. (Jackson, Ohio, USA) for the child(ren) above to participate without restriction, unless otherwise stated, in the 2026 Vacation Bible School event.

If you have further questions, concerns, or restrictions, please call New Covenant Worship Center, Inc. at 740-288-3951.
Should be Empty:

Registration Form

Emergency Medical Authorization

Part 1-To Grant Consent