Illumination Station VBS Registration

Illumination Station VBS Registration

We pray that you will join us for Vacation Bible School
Friday, June 26th 6:00pm to 8:00pm _{^{(check-in begins at 5:30pm)}}
Saturday, June 27th 9:00am to 4:00pm _{^{(check-in begins at 8:30am)}}
Sunday, June 28th 9:30am to 11:30am * _{^{(check-in begins at 9:00am)}}
^{*luncheon following Sunday morning session in the Family Life Center for VBS families.}

Please register each child or youth separately!

Parental Authorization, Consent, & Release Agreement

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Child's name

First

Last

Child's date of birth *

Child's Grade Level *

Choose your age at the time of VBS or child’s grade level for next school year. Illumination Station VBS is for ages Preschool (3) through High School.

If your child is ages 3 to 4, are they potty trained? (All children must be potty trained to attend)

Does your child attend church? *

If yes, where?

Parent/Guardian Name *

First

Last

name ages Phone

Parent/Guardian Email *

Parent/Guardian Phone *

Mailing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Emeregency Contact Name

First

Last

Other than parent/guardian listed above

Phone

Who may pick up your child at the end of VBS each day?

NOT including parent/guardian listed above please list any additional people who are allowed to pick up your child from VBS. Photo ID required and name must be included in this list.

Name

First

Last

Name

First

Last

Name *

First

Last

Parental Authorization, Consent, & Release Agreement *

I agree and give my permission (for more information use link at bottom of page)

I acknowledge and understand that this PARENTAL AUTHORIZATION, CONSENT AND RELEASE has the same force and effect regardless of whether the activities engaged in are free or if a fee is charged. Further, I personally assume, on my child’s behalf, all risk in connection with said activities for any harm, injury or damages that may befall my child as a result of my child’s participation in the activities, whether foreseen or unforeseen, and I still wish to allow my child to proceed with the activities.

In consideration of my child being allowed to participate in these activities and to use Refuge Baptist Church, equipment and facilities, on behalf of my child, I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless Refuge Baptist Church and its staff and volunteers, from any and all claims, demands, or causes of action, which are in any way connected with my child’s participation in these activities or use of Refuge Baptist church, equipment and facilities.

I understand that it is my obligation to inform the church of any and all health considerations or medical conditions that would restrict my child’s participation in any and all activities while in the care of Refuge Baptist Church. Should the need for medical attention arise the church will attempt to contact me as soon as practicable under the circumstances.

In cases of emergency, I further consent to the examination or treatment of my child by a physician duly licensed to practice medicine in the United States of America or any health care professional duly licensed to provide health care serviced in the United States of America for medical care and services deemed necessary by the doctor, its agents, servants, and employees. I give permission to the doctor or health care professional to provide any and all medical care they deem, in their professional opinion, to be necessary. I agree to pay for any and all medical expenses incurred as a result of the use of this consent.

I acknowledge by submitting this document, that if anyone is hurt or property is damaged during my child’s participation in these activities, I may be found by a court of law to have waived my right to maintain a lawsuit against the church on the basis of any claim form which I have released them herein. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions remain in full force and effect. I have fully informed myself to the contents of this PARENTAL AUTHORIZATION, CONSENT AND RELEASE by reading it before I signed it.

Photo Release *

Yes, you can use pictures and videos of my child. I hereby grant Refuge Baptist Church permission to use my child’s likeness in photographs, video, and other media in any and all of its publications, including bulletin boards and website entries. I waive any right to royalties or other compensation arising or related to the use of the photographs or videos.
No—please do not print or publish photos of videos of my child online or in church-related publications.

Refuge Baptist has a website, Facebook, and Instagram where photos and videos from our events are periodically published. We also have a bulletin board where we sometimes post photos from events. It is Refuge’s policy that photos of children are never published with names or other identifying information.

Medical Information:

This information must be filled out to register.

Does your child have allergies? *

If yes, please list all allergies:

Does your child take medication that we should be aware of during VBS? *

If yes, please list medications:

How did you hear about the Illumination Station VBS? *

Facebook/Instagram/Website
Flyer/Mailer
Sign
Other

Parental Authorization, Consent, & Release Agreement