Clone of Calvary Chapel Glendale VBS 2025 Consent Form

STUDENT INFORMATION

Name

First NameLast Name

Gender

Birth Date

Date

Parent/Guardian Phone Number

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

Parent/Guardian Email

example@example.com

EMERGENCY CONTACTS
Please list the first and last names and phone numbers off ALL adults who are allowed to pick up this child. The child will only be released to these people.

Alternate Parent/Guardian

First NameLast Name

Phone Number

Format: (000) 000-0000.

Medical Information

Please list all allergies -- or type "none" if there are none

Does your child carry an epi-pen? (please note: if yes, it is the responsibilty of the child's guardian to ensure the child has the epi-pen at every drop off and pick up)

Please list all medical concerns -- or type "none" if there are none

Additional Information

VBS photos/videos are taken for promotional purposes related to Calvary Chapel Glendale. These pictures appear in various media outlets such as Instagram and our facebook page and webpage. Do you allow your child to be included in these photos/videos?

By signing this form, I agree to release and hold harmless the Calvary Chapel Glendale VBS program, held from June 18th to 19th, 2026, including its staff and volunteers, from any claims or liability arising from my child’s participation.

Signature

VBS 2026 Consent Form

Medical Information

Additional Information