VBS Registration

Child's First Name

Child's Last Name

Age

Birthdate

Gender

Registering For:

Last Grade in School Completed

Parent's First Name

Parent's Last Name

Address

City

State

Zip

Primary Phone #

Secondary Phone #

Any Allergies or Medical Conditions we should be aware of?

Yes No

Explanation of Allergies or Medical Condition:

T-shirt Size

Emergency Contact - First Name

Emergency Contact - Last Name

Emergency Contact - Phone #

Relationship

Any special friend your child would like to be grouped with?

Covid-19 Guidelines
I understand that children should not attend this event if they are experiencing a cough, fever, shortness of breath or have had exposure to Covid-19.

Liability and Medical Release
This child has my permission to attend Youth Ministry Programs at Valencia Presbyterian Church. I release the Valencia Presbyterian Church and its employees/volunteers from all liability for any injury that may occur while on the premises at this time. I hereby authorize Valencia Presbyterian Church to administer basic First Aid to this child and to seek professional medical treatment if necessary.

Publicity
On occasion, Valencia Presbyterian Church may take photographs or make an audio or video tape recording of children and/or adults involved in church activities to be used by staff and participants as an event keepsake or in publications or advertising materials to let others know about our ministry. I consent to the use of any such audio or visual record of myself/my child to be used as the church sees fit.

Vbs Registration

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