La Salle VBS Registration 2016
Parent (First Name)
*
or Guardian(s)
Last Name
*
Manitoba Health Number
*
6 digit family number
Primary Phone #
*
Cell Phone #
*
Parent E-mail
*
or Guardian(s)
Address
Street Address
City/Town
Postal Code
Emergency Contact
*
Primary Phone #
*
Child (First Name):
*
Last Name:
*
Grade (Sept 2016)
*
Please Select
Kindergarten
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
(As of September 2016)
Medical #
*
9 digit
Gender
*
Male
Female
Are there any allergies or special considerations we should be aware of for the child listed above?
Photo Release: Throughout the week of VBS, photographs will be taken of individuals and groups participating in various activities. Your child(ren) may be captured in these photographs. We will be using these photos to put together a powerpoint presentation to show at our closing program, as well as to update our website, www.lasallevbs.ca. Please indicate your agreement or non-agreement below.
*
Yes, I give permission for photos of the child listed above to be used.
No, I do not give permission for photos to be taken of the child listed above.
*
Parent/Guardian Signature
Waivers and Conditions of Enrolment: While all reasonable precautions are taken for the safety and good health of our campers, Kingdom of the Son VBS 2016 and its directors and volunteers are hereby released from any and all liability in the event of any illness, accident, or misfortune that may occur to the camper. Each camper must be covered by Provincial Health or equivalent medical insurance. The signature of the parent/guardian on this registration shall give the Vacation Bible School (VBS) volunteers the right to approve and obtain medical attention necessary for the camper's welfare and good health including injection, anesthesia or surgery. In such situations, VBS volunteers will attempt to notify the parents/guardians as soon as possible. The parents/guardians are responsible for any additional expense that may result from such services. I have read and agree with the waivers and conditions.
*
Signature of Parent/Guardian
Do you have another child to add?
Yes
No
Once your form is submitted you will be redirected to this form to add another child.
May La Salle Community Fellowship send you emails regarding upcoming events?
*
Yes
No
By submitting this form electronically, I accept the terms & conditions as listed above.
*
Please check box
Submit
Should be Empty: