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*Please fill out a separate form for each child
Register for SonSpark Labs VBS!
June 20-24th, 9:00 am to Noon
*
Indicates required field
Child's Name
*
First
Last
Please fill out a separate form for each child.
Child's Age
*
T-Shirt Size
*
Youth Small
Youth Medium
Youth Large
Last School Grade Completed
*
K
1st
2nd
3rd
4th
5th
Phone Number
*
Parent/Guardian's Name
*
First
Last
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Email
*
Home Church (Optional)
*
Allergies/Other Medical Conditions
*
Who has permission to pick up your child?
*
Please list.
In Case of Emergency, Contact
*
First
Last
Phone Number
*
Relationship to Child
*
I give permission for photographs or videos of my child to be used by Hucrest Community Church of God and/or Roseburg Alliance Church for historical and/or promotional purposes including Hucrest Community Church of God and/or Roseburg Alliance Church's print, web, and social media.
*
Photo Permission Given
Photo Permission Denied
I hereby give my consent to have my minor child participate in the following activity of
Hucrest
Community Church of God in collaboration with Roseburg Alliance Church
: Vacation Bible School (hereafter “the activity”) on or about June 20, 21, 22, 23, and 24, 2016
.
I recognize that there are risks involved in participating in this activity and hereby assume all risk
of injury, harm, damage, or death to my minor child in connection with his-her participation in
this activity.
To t
he fullest exten
t perm
itte
d by law, I rele
ase
Hucrest Community Church of God and Roseburg Alliance Church, their
trus
tee
s, off
icers
, dire
ctor
s, empl
oye
es, age
nts and repr
ese
ntat
ives from any inju
ry
, harm
,
damage or death which may occur to my minor child while participating in the activity and agree
to sav
e an
d ho
ld har
ml
es
s
Huc
re
st Co
mm
uni
ty Chu
rch of God and Roseburg Alliance Church
, their trus
tee
s, off
icers
,
directors, employees, agents and representatives from any claims arising out of my minor
child's participation in the activity.
Further, being the parent or legal guardian of the minor child, I do consent to any medical,
surgical, x-ray, anesthetic, or dental treatment that may be deemed necessary for my minor
child. I understand that ef
forts will be made to contact me prior to treatment but
, in the event I
can
not be reac
hed in an emergen
cy
, I give permi
ssio
n to the acti
vity leade
r to make the
de
cis
io
ns ne
ce
ssa
ry for trea
tme
nt. Sh
ou
ld the
re be no act
ivi
ty lea
de
r ava
ila
ble
, I gi
ve
perm
issi
on to the atte
ndi
ng physi
cian to treat my minor child. As pare
nt or leg
al guardi
an, I
understa
nd that I am responsible for the health care decisions of my minor child and agree that
my ins
ura
nce plan is th
e pri
ma
ry pla
n to pa
y fo
r the medi
cal
, de
nta
l, or ho
spi
tal ca
re or
treatmen
t that is given to my minor child. Any insu
rance policy of the ch
urch or organiza
tion
sponsoring this event will be used as the secondary coverage.
I am the child's parent or legal guardian and I have read and agree to the authorization above. FULL NAME BELOW
*
To sign, please type your full legal name.
By checking 'yes' I certify that I am the child's parent or legal guardian.
*
Yes
No *Please bring a paper copy of the Emergency Form below (signed by parent/legal guardian) prior to VBS
Submit
Emergency Consent Form
File Size:
114 kb
File Type:
pdf
Download File
Home
About
I'm New
Staff
Find Us
Sermons
September 2020
August 2020
July 2020
June 2020
May 2020
April 2020
March 2020
February 2020
January 2020
December 2019
November 2019
October 2019
September 2019
June 2019
May 2019
April 2019
March 2019
December 2018
November 2018
October 2018
September 2018
August 2018
July 2018
June 2018
May 2018
April 2018
March 2018
February 2018
January 2018
Resources
Prayer
Calendar
Pastor Jon's Blog
Give
Contact