VBS Registration

*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

Child's Age *

T-Shirt Size *

Youth Small Youth Medium Youth Large

Last School Grade Completed *

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? *

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 the fullest extent permitted by law, I release Hucrest Community Church of God and Roseburg Alliance Church, their trustees, officers, directors, employees, agents and representatives from any injury, harm, damage or death which may occur to my minor child while participating in the activity and agree to save and hold harmless Hucrest Community Church of God and Roseburg Alliance Church, their trustees, officers, 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 efforts will be made to contact me prior to treatment but, in the event I cannot be reached in an emergency, I give permission to the activity leader to make the decisions necessary for treatment. Should there be no activity leader available, I give permission to the attending physician to treat my minor child. As parent or legal guardian, I understand that I am responsible for the health care decisions of my minor child and agree that my insurance plan is the primary plan to pay for the medical, dental, or hospital care or treatment that is given to my minor child. Any insurance policy of the church or organization 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 *

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

Register for SonSpark Labs VBS!June 20-24th, 9:00 am to Noon

Register for SonSpark Labs VBS!
June 20-24th, 9:00 am to Noon