VBS 2023 Twists & Turns

Parent Information

First Name

Last Name

This address will receive a confirmation email

Address

Contact Phone 1

Contact Phone 2

Employer Name

Employer Phone

Home Church Affiliation

Are you volunteering on site?

Yes No

Will your child be picked up at the same time as a teenage volunteer?

Yes No

Tell us about your Participant

Participant's Name

Grade Entering

T-shirt size

XS YS YM YL YXL AS

Gender

Birthdate

I understand my child has to be 4 on or before September 1st and potty trained to attend VBS

Yes No

Medical/Health Insurance Information

Medical Doctor Name

Medical Doctor Phone Number

Any Allergies/Medications/Medical Issues

Emergency Contact Name

Emergency Contact Phone

Alternate Pick-up Name

Alternate Phone Number

Please list the name(s) of anyone who has permission to pick up your child. If the individual is not listed on the registration form, they will not be permitted to pick up your child.

Daily Snack Information: Each day your child will be given a themed snack to go along with our Bible Story. Please indicate whether your child can or cannot have the provided snack.

Do you have a friend you would like to be with? We cannot guarantee friend requests, but we will do our best. Friend requests MUST be in the same grade and submitted before 5/1/23. List friend's first and last name here.

Permission for Publicity

On occasion, Gulf Breeze Presbyterian Church takes photographs or makes an audio or videotape recording of children and/or adults involved in church/youth activities. I consent to the use of any such audio or visual records of the child names above or me, if I am participating to be used, distributed or displayed as agents of the church see fit.

Permission for Publicity

I give permission I DO NOT give permission

Permission/Waiver Release of Liability

By signing this waiver form, I grant permission for the child named above or I, if I am a participant, to participate in and engage in the VBS Program of Gulf Breeze Presbyterian Church. My child or I are physically and mentally able to participate in these activities unless I have already discussed it with one of the leaders. I acknowledge that there are certain risks involved in said activities and have discussed them with my child if necessary. I release Gulf Breeze Presbyterian Church, its affiliates, volunteers, and employees of all responsibilities for any injuries, to body or property, which may occur to my child during these activities, except for negligence. In the event of an emergency, in which I or the alternate contact cannot be reached, I authorize the adult leaders to make medical decisions for my child, and to administer first aid, if deemed necessary. I further agree to indemnify and hold harmless Gulf Breeze Presbyterian Church and its affiliates, volunteers, and employees of any and all claims arising from my child’s or my participation in activities or as a result of injury or illness of my child or me during such activities, including but not limited to exercising any medical decisions or administering any first aid in the circumstances referred to above, except for negligence. I represent that I am the participant, or parent/guardian of child listed above, who is under 18 years of age. I have read the Permission/Waiver Form and am fully in agreement with the contents thereof. I give permission for the child named above or I to fully participate in the activities of Gulf Breeze Presbyterian Church.

Signature of Participant or Parent/Guardian

Date:

VBS 2023 Twists & Turns - PARTICIPANT

Description

VBS 2023 Twists & Turns - PARTICIPANT

Description

Please Fix the Following