| Last Name: |
First Name: |
Age: |
Date of Birth (MM/DD/YY) |
Child's Grade (next year) |
| Child's sex: |
Child's address: |
City: |
State: |
Zip: |
| Parent's/Guardian's Name: |
Parent's/Guardian's Phone: |
Cell Phone: |
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| Persons to be contacted in case of emergency: |
Does your child have medical conditions that we should be
aware of? (allergies, medications, etc.)
If so, please explain: |
Siblings who will also be attending VBS: |
My child would like to be in class with the following
friend or friends: |
I WOULD LIKE TO VOLUNTEER to help with: |
| We will need child care for child/children, aged: |
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| The undersigned gives permission to his or
her child to participate in the above named activity and releases
Sabinal Methodist Church, its officers, employees, and agents from any
liability whatsoever for any injury or death to person or loss or damage
to property sustained by the undersigned for any member of his family,
in attendance, and the undersigned agrees to defend and indemnify
Sabinal Methodist Church, its officers, employees, and agents from any
liability or loss they might sustain by reason thereof. In the event I
cannot be reached in an EMERGENCY, I hereby give permission to the
physician selected by the director of children's ministry to
hospitalize, secure proper treatment for, and order injections,
anesthesia, or surgery for my child as named above.
Signed:
Date:(MM/DD/YY) |
| Insurance Company:
Policy No. |
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| By signing this registration form you agree
that any photographs taken of your child at or during this event are the
property of Sabinal Methodist Church and may be used in future
publications as deemed appropriate. |