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    Student's Full Name (required)

    Age(4-12) (required)

    Gender        T-Shirt Size              Allergies(If Any)

             

    Parents' Full Names (required)                             Emergency Phone (required)

       

    Alternate Emergency Phone (required)                                 Email (required)

       

    Medical conditions or Other Needs (Need Ride?/Days Attending, etc.)

    Terms and conditions:

    Note: Although we set ourselves to work hard and give the safest environment for VBS we are required to take this release

    Medical Release: I give my permission for the VBS staff to administer basic first aid to my child (named above) in the event of an injury. I understand that the VBS staff will contact emergency services in the event of a significant injury and all expenses for such emergency services will be paid by me.

    Photo Release: I hereby grant the above-named church permission to copyright and use photographs/videos taken at VBS of the minor designated above in any manner or form for any purpose lawful at any time. I waive my right that I may have to inspect or approve the finished product or written copy, that may be used in conjunction therewith, or the use to which it may be applied.

    Parental Consent: By checking this box, I agree to all the terms and conditions mentioned above.