Round Grove VBS 2023

Participant Information

Child's Name

Address

Gender

Male Female

School Attending

Would you like to be contacted about special assistance for this participant? (sensory, disability, special needs)

yes no

Church you regularly attend (if any)

Guest of (if any)

Allergy (if any)

VBS Themed T-Shirt

FREE T-SHIRTS (based on timing of registration and shirt availability). If you would like to donate towards the cost of shirts, you may choose an amount below to pay on-line or bring cash donation on first night.

Preferred T- shirt Size (pending availability)

T-shirt Donation

Parent/Guardian Information

Parent/Guardian Name(s)

Parent/Guardian Phone

Alternative Parent/Guardian Phone

This address will receive a confirmation email

Emergency Contact Name

Emergency Contact Phone Number

Arrival & Dismissal

For safety and security reasons, we have implemented certain processes for all children in our care:
CHECK-IN: Child checks in at Registration Table for attendance, group assignment, and to receive name tag. If on-line registration has not been completed, parent/authorized individual needs to register child.
CHECK-OUT: Parent/authorized adult signs check out sheet held by group leader at Closing Rally.

Names of people allowed to check in or pick up child (other than parents listed)

Other

By checking this box, I give permission for Round Grove Baptist Church to obtain medical attention for my child in the event of an emergency (and when a parent or emergency contact cannot be reached):

Yes

I give permission for my child's photos to be used in print/online at the discretion of Round Grove Baptist Church. I understand that my child will NOT be named or tagged in any photo.

Yes No

LIABILITY RELEASE: In consideration of Round Grove Baptist Church allowing the Participant to participate in kid's ministry, I, the undersigned, do hereby release, forever discharge and agree to hold harmless Round Grove Baptist Church, its pastors, directors, employees, volunteers and teachers (collectively herein the “Church”) from any and all liability, claims or demands for accidental personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the Participant while involved in church activities. I the parent or legal guardian of this Participant hereby grant my permission for the Participant to participate fully in church activities. Furthermore, I, on behalf of my minor Participant, hereby assume all risk of accidental personal injury, sickness, death, damage and expense as a result of participation in recreation and work activities involved therein. The undersigned further hereby agrees to hold harmless and indemnify Round Grove for any liability sustained as the result of the negligent, willful or intentional acts of said Participant.

I AGREE

Form Completed by:

Relationship to Child:

By entering my name in above field, I am providing my digital signature on this form and confirming information is correct and accurate.

I AGREE

ADDITIONAL COMMENTS:

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Round Grove VBS 2023

Description

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