VBS Registration Page | First United Methodist Church

Parents' Names *

First

Last

First

Last

Address *

Email *

Confirm Email

Home Phone *

If no home # enter cell number

Cell Phone *

If no cell # re-enter home phone

Church Affliation *

Name of church you regularly attend. If no church put n/a

Child's name *

First

Last

Child's Age *

Gender *

Male
Female

Date of birth *

Grade Completed Spring 2019 *

T-Shirt Size *

Please register by June 10th to be guaranteed a t-shirt.

Please List any allergies (including food allergies) or any other medical conditions that VBS Staff should be aware of. *

If you have none, please put "n/a."

Emergency Contact *

First

Last

Emergency Contact Phone Number *

Relationship to Emergency Contact *

Vacation Bible School 2019 Waver and Permission Form *

I have read and understand this Waiver and Permission Form

By checking the box above and completing this online registration, I acknowledge that the participation of my child in this event could involve risk of physical injury or damage to property. I expressly assume such risk and release and waive any claims against the First United Methodist Church of Harvard, its agents and employees, for any injuries to persons or damage to property, whether the result of negligence, breach, warranty, or otherwise. I further agree to hold the First United Methodist Church, it's agents and employees, harmless for any injury to persons or property damage caused by involvement in this activity. If I cannot be reached, I authorize the VBS Staff to provide emergency medical/dental care for my child in the event of a sudden illness or injury while under their care and supervision. I also agree to pay all medical/dental fees and costs as secured or authorized under this consent. I authorize the VBS Staff to use and release photographs of my child for purpose of publicity or news items.

Phone