Adult Registration Form
Please Note: Separate registration forms must be completed for each person participating in Vacation Bible School.
True North VBS Registration - Mossy Living Word Church
Adult Participant Name
*
First Name
Last Name
Gender
*
Male
Female
Birthdate
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Email
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone or Cell Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Information
*Allergies, Medical Conditions, or Special Needs (If none, put N/A)
*
*In Case of Emergency, Contact
*
*Emergency Contact Relationship
*
*Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Do we have permission to take photographs/videos of you during VBS?
*
Yes
No
If so, do we have permission to post photographs/videos on social media?
*
Yes
No
Do you currently have a home church?
Yes
No
If Yes, Where?
Liability Agreement and Waiver
I understand and acknowledge that I have voluntarily chosen to allow myself/my child to participate in Vacation Bible School hosted by Mossy Living Word Church. I understand that all reasonable safety precautions will be taken by the staff and volunteers of Mossy Living Word Church during this event. I understand that participation in VBS may involve activities that carry a risk of injury, and I assume full responsibility for any such risks. I agree not to hold Mossy Living Word Church, its staff, volunteers, or affiliates liable for any accident, injury, or illness that may occur during participation in Vacation Bible School.
Signature
*
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