VBS 2016 Registration

August 1st-5th, 6pm-8pm | Please fill out this form, initial for consent, and click submit.

Parent Name

Parent Email

This address will receive a confirmation email

Parent Phone

Name of Adult Registering Child(ren) if different than Parent:

Please list all persons (other than yourself) that have consent to pick up your child(ren):

Child #1 Name

Child #1 Grade

Please select one option.

2 Yrs 3/4 Yrs K 1st 2nd 3rd 4th 5th 6th

Child #2 Name

Child #2 Grade

Please select one option.

2 Yrs 3/4 Yrs K 1st 2nd 3rd 4th 5th 6th

Child #3 Name

Child #3 Grade

Please select one option.

3/4 Yrs K 1st 2nd 3rd 4th 5th 6th 2 Yrs

Child #4 Name

Child #4 Grade

Please select one option.

3/4 Yrs K 1st 2nd 3rd 4th 5th 6th 2 Yrs

Child #5 Name

Child #5 Grade

Please select one option.

2 Yrs 3/4 Yrs K 1st 2nd 3rd 4th 5th 6th

Medical Release Form

Emergency Contact Name (if parent cannot be reached) :

Emergency Contact Phone Number:

Are there any medical conditions, medication(s), or allergies we should be aware of?

I (we), the undersigned parent(s) or guardian(s) of the above child(ren) (a) minor(s), do hereby authorize adult volunteers of New Haven Church as agent(s) for the undersigned, to consent to any medical or surgical care deemed advisable by any accredited physician or surgeon in an approved emergency clinic or hospital. INITIAL BELOW:

I (we), the undersigned parent(s) or guardian(s) of the above child(ren) I further release from any liability New Haven Church any of its ministries or leaders in the event of an accident , during the above mentioned event. This agreement does not apply to claims for intentional misconduct or gross negligence. INITIAL BELOW:

Any other information that we should be aware of in regards to your child(ren):

Description

August 1st-5th, 6pm-8pm

Please fill out this form, initial for consent, and click submit.

VBS 2016 Registration

Description

Please Fix the Following