VBS | tabernaclecogic

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VBS 2024

Child's First Name

Child's Last Name

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Birthday

Allergies/Medications/Medical Conditions

Address (leave blank if same)

Emergency Contact Phone Number

Child's Age

Grade Completed

Parent/Guardian Name

Cellphone Number

Emergency Contact Name & Relation

I accept the following terms & conditions: I understand that reasonable precautions will be taken to safeguard the health and well-being of the participants in this VBS and that I will be notified as soon as possible in the event of an emergency. In the case of sickness or an accident, I authorize and consent the VBS Team, or other associated volunteers of the VBS program to obtain medical care from a licensed physician, hospital, or medical clinic for my son/daughter in the event that myself or other legal guardian(s) cannot be reached. I hereby do release and forever discharge the Tabernacle COGIC, and Parish from all manners of actions, and claims, which I or the child named above shall or may have for any reason, arising during my child’s attendance of the VBS. Unless other written instruction is submitted, I also consent to allow my child’s image to be recorded, either by photograph or video and used for future advertisement of the VBS program.

Your Signature