2025 Vacation Bible School Registration- Just Like Me

Child #1 Name

Child #1 Birthdate

Grade Child #1 just completed

Child #2 Name (First and Last)

Child #2 Birthdate

Grade Child #2 just completed

Child #3 Name (First and Last)

Child #3 Birthdate

Grade Child #3 just completed

Child #4 Name (First and Last)

Child #4 Birthdate

Grade Child #4 just completed

Parent/Guardian Name

Parent/Guardian email

This address will receive a confirmation email

Parent/Guardian Work/Cell Phone

Address (physical address of child/family)

I give consent for any photos of my child(ren) taken during VBS to be used in media and publications such as the Arkive and Ark & Dove website.

YES NO

Emergency Contact Name

Emergency Contact Phone

Please list any allergy, dietary or medical concerns of your child (ren).

If applicable, please provide information that would help with academic or emotional needs of your child(ren).

I hereby understand that my child(ren)will be supervised and that if a health problem or injury arises, I will be notified. If I cannot be reached by phone, medical treatment and/or hospital care will be administered by competent medical personnel including medication, injections, anesthesia, surgery, or other proper treatments and necessary information may be released for insurance purposes. I verify that all health issues are so noted on this form.

YES NO

LIABILITY RELEASE: In consideration of Ark and Dove allowing the above child(ren) to participate in Vacation Bible School activities, I, the undersigned, do hereby release, forever discharge, and agree to hold harmless Ark and Dove, its directors, employees, volunteers, and agents (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 above child(ren) while involved in Vacation Bible School. Furthermore, on behalf of my minor child(ren), I hereby assume all risk of accidental personal injury, sickness, death, damage, and expense as a result of participation in activities involved therein.

YES

I acknowledge that the information I provided on this form is accurate, to the best of my knowledge:

YES

To offset the cost of this program a suggested donation of $25 (MS) and/or $5 (PK-5th grader) is recommended.

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

2025 Vacation Bible School Registration- Just Like Me

Description

Please Fix the Following