VBS 2021 Registration

Parent/Guardian Name

This address will receive a confirmation email

Mobile Phone

Address

Do you currently have a church home where you regularly attend?

If yes, what is the name of that church? (Otherwise, type N/A)

Medical, Media, and Liability Releases

In the event of an emergency in which my child is in need of immediate medical attention, hospitalization or surgery, and after reasonable efforts have been made to contact me (parents or guardian) and we can not be located for the purpose of consenting thereto, consent for the emergency attention may be given to any person standing to loco parentis to my child. I understand my own medical insurance will be the primary coverage. I hereby release First Baptist Church, its staff and volunteers, of the liability for injury or damage and assume all risks stemming from my child's participation in VBS. I understand that during VBS my child may be videotaped or photographed. By signing this form I am giving permission for my child to appear in photos or videotape in First Baptist Church services or promotional materials. I give my child's VBS leader permission to contact my child through written communication. This release is completed of my own free will. Typing my name constitutes my signature. Granting my permission:

I understand that while First Baptist Church of Mount Orab is taking reasonable measures to help prevent the spread of COVID-19, there is an inherent risk of exposure to and transmission of infectious viruses like COVID-19 in any public space where many people are present. I understand that it is my decision to allow the child(ren) herein registered to participate in Vacation Bible School given the risks associated with a summer activity environment. After fully and carefully considering all the potential risks involved, I hereby assume the same and agree to release and hold-harmless the First Baptist Church of Mount Orab and its trustees, employees, volunteers, and representatives from and against all claims and liability resulting from exposure to disease-causing organisms and contaminated objects, such as COVID-19, associated with attending and participating in Vacation Bible School at First Baptist Church of Mount Orab. By selecting "I Accept", I am signing this hold-harmless agreement.

I Accept

Child # 1 Information

Child Name

Gender

Male Female

Grade Just Completed

List Allergies (if none, please type N/A)

Child # 2 Information

Child Name

Gender Male Female

Grade Just Completed

List Allergies (if none, please type N/A)

Child # 3 Information

Child Name

Gender Male Female

Grade Just Completed

List Allergies (if none, please type N/A)

Child # 4 Information

Child Name

Gender Male Female

Grade Just Completed

List Allergies (if none, please type N/A)

VBS 2021 Registration

Description

Please Fix the Following