VBS - Participant Registration

Child's Name *
Child's Name
Birthday *
Birthday
Home Phone *
Home Phone
Parent/Guardian 1 Name *
Parent/Guardian 1 Name
Cell Phone *
Cell Phone
Parent/Guardian 2 Name
Parent/Guardian 2 Name
Cell Phone
Cell Phone
Emergency Contact Name *
Emergency Contact Name
Emergency Contact Phone *
Emergency Contact Phone
Days Your Child Will Attend *
Terms and Conditions *
1) I understand that my child/children may participate in physical activities such as those held during Game Time. As with any physical activity, there is a risk of injury. I fully accept this risk and hold harmless from any legal liability, Pleasant Grove Baptist Church and any persons involved in the VBS ministry. 2) In the event of an emergency that requires medical treatment for the above named child/children, I understand every effort will be made to contact me or my emergency contact. However, if I/we cannot be reached, I give my permission to the VBS volunteers to secure the services of a licensed physician to provide the care necessary for my child's well being. I assume responsibility for all costs connected to any accident or treatment of my child. 3) I grant permission to Pleasant Grove Baptist Church for the use of photograph(s) of my child's image in any presentation of any and all kind whatsoever. 4) I grant permission for my child to travel to/from VBS events with an adult leader. Any such event will be clearly communicated with me beforehand. 5) I understand that my child must be accompanied by an adult at all times and I agree to escort my child into the building to be signed in. I agree that only the persons designated on this form may pick up my child. When picking up my child I will go to the designated sign out area and will sign out using the appropriate form. I will make sure that my child is accompanied by an adult at all times while on the Church property.