2016 CA VBS Sign Up (July 15-17)

Parent/Guardian Name(s)

Address

This address will receive a confirmation email

Phone

1st Child's Information

Name

Birth Date

Grade for 2016-2017 School Year

Allergies / Food Restrictions

2nd Child's Information

Name

Birth Date

Grade for 2016-2017 School Year

Allergies / Food Restrictions

3rd Child's Information

Name

Birth Date

Grade for 2016-2017 School Year

Allergies / Food Restrictions

4th Child's Information

Name

Birth Date

Grade for 2016-2017 School Year

Allergies / Food Restrictions

Emergency Contact Information

1st Emergency Contact

Name / Relationship to Child

Phone

2nd Emergency Contact

Name / Relationship to Child

Phone

Permissions

By selecting YES, I am giving permission for my/our child(ren) listed above to attend and participate at VBS, which will include physical activities, games and walking to the beach with VBS adult leaders. On behalf of my/our child(ren), I/we assume the risk and promise to release, forever discharge and hold harmless Monterey Church, it's directors, staff and volunteer leaders from any and all liability for personal injury, sickness and damage to personal or public property which might result from my/our child(ren)'s participation in any and all VBS activities. This covenant to hold harmless extends to each child listed above and their participation in any events and activities. Also, I hereby grant permission for my child(ren) listed on this form, to be included in pictures, promotional material, and publications connected with GOKids at Monterey Church. My child’s picture may appear in publications and promotional materials, such as, but not limited to, as follows: www.MontereyChurch.net, Social Media Sites directly connected to Monterey Church (Facebook, Instagram, Twitter); PowerPoint Presentations, church brochures, postcards, and flyers.

Yes No

By selecting YES, I am declaring that I am the parent or guardian of the child(ren) identified above. I hereby approve and consent to the terms mentioned above. I affirm that I have the legal right to issue such consent.

Yes No

(Consent Signature) Parent / Guardian's Name

Date

2016 CA VBS Sign Up (July 15-17)

Description

Please Fix the Following