VBS 2024 Registration

Parent Information

Parent name *

Street Address *

City *

State *

Zip code *

Phone number *

Email *

Child 1 Information

Child's name *

Age: years *

Date of birth * +

Current Grade *

Does the child have any allergies? If so, please explain.

Other notes or requests?

Child 2 Information (optional)

Child's name

Age: years

Date of birth +

Current Grade

Does the child have any allergies? If so, please explain.

Other notes or requests?

Child 3 Information (optional)

Child's name

Age: years

Date of birth +

Current Grade

Does the child have any allergies? If so, please explain.

Other notes or requests?

Emergency Contacts

Emergency contact 1 name *

Emergency contact 1 phone number *

Relationship to child: *

Emergency contact 2 name

Emergency contact 2 phone number

Relationship to child:

Comments

Services

Days Child 1 will attend (choose all that apply) *

Monday (July 8th)

Tuesday (July 9th)

Wednesday (July 10th)

Days Child 2 will attend (choose all that apply)

Monday (July 8th)

Tuesday (July 9th)

Wednesday (July 10th)

Days Child 3 will attend (choose all that apply)

Monday (July 8th)

Tuesday (July 9th)

Wednesday (July 10th)

Liability Release Form

I do hereby release, forever discharge and agree to hold harmless Pacific Bible Church and the directors therof from any and all liability, claims, or demands for personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the participant(s) that occur while said person(s) is attending and traveling to and from Vacation Bible School from July 8th-10th, 2024. The undersigned further hereby agrees to hold harmless and indemify said church, its directors, volunteers, employees, and agents for any liability by said participant(s), including expenses incurred attendant thereto.

The undersigned further consents to the administration of first aid and/or doctor's care, or any other form of medical treatment necessitated by illness or injury that may require the same. In the event of the necessity of such care or treatment as heretofore described, the undersigned agrees to hold harmless and indemify said church, its directors, volunteers, employees, and agents from any acts of malfeasance, and/or failure to act on the part of those chosen to administer medical care on behalf of the participant(s).

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Print name *

Date of Signature * +