Request edit access
VACATION BIBLE SCHOOL - 2018 STUDENT REGISTRATION
Event Dates: June 18- 22, 2018
Event Times: 9:30 am - 12:30 pm
Event Address: 5095 LaVista Road, Tucker, Georgia 30084
Event Director: Mimi Sanders - Contact (678) 325-4038 or mimi_sanders@tfumc.org
Email address *
Child's First Name *
Your answer
Child's Last Name *
Your answer
Child's Date of Birth *
MM
/
DD
/
YYYY
Child's 2018-19 School Grade *
Child's T-Shirt Size *
Primary Parent/Guardian First Name *
Your answer
Primary Parent/Guardian Last Name *
Your answer
Primary Parent/Guardian Phone Number *
Your answer
Secondary Parent/Guardian Name and Phone Number
Your answer
Allergies or Medical Conditions *
Your answer
Other information we should know: *
Your answer
RELEASE FOR USE OF PHOTOGRAPHS & VIDEO FOOTAGE In return for good and valuable consideration, receipt of which I acknowledge, I hereby grant to Tucker First United Methodist Church and The United Methodist Publishing House, its clients and any other persons or entitles with whom it may contract for the use of such photographs and video footage, the unlimited right and permission to use the photographs and video footage described below (the “usage”) of my child or ward named above. DATES VIDEO OR PHOTOS TAKEN: June 18-22, 2018 LOCATION OF VIDEO OR PHOTOS--- Tucker First UMC, 5095 LaVista Road,Tucker, GA 30084. I further grant to TFUMC and/or UMPH the right to crop, edit, and otherwise alter the photographs and/or video; as well as combine them with other photographs and/or video or graphic elements. I waive my right to inspect the photographs or video or any version of them or any finished advertisement or printed or other materials into which they may be incorporated. I further understand that by signing this release, I waive any claim I might otherwise have for invasion of privacy due to the publication of the photographs and/or video. I hereby consent to their publication in any form in any medium or periodical or other publication, alone or in conjunction with any printed or visual matter that may be published with them. I warrant that I have reached the age of majority and have every right to grant the permissions herein granted. Further, I represent that I have read this document before signing it and understand its provisions. *
Required
PARTICIPATION AGREEMENT AND MEDICAL AUTHORIZATION - I the parent or legal guardian of the participant listed on this form, give permission for my child/ward named above to be involved in the Tucker First United Methodist Church VBS and its activities. It is my intention to, and I do hereby surrender and waive any rights to sue or exercise any legal right to seek damages for the covered parties from their failure to use reasonable care in any way. I further understand that my signature grants permission for the Director of Children's Ministry, the VBS Director, or any other Tucker First UMC designee to take the participant to the doctor or hospital in the case of injury or illness, and I hereby authorize medical treatment, and hereby assume financial responsibility for all expenses incurred for such treatment, sickness, death, damages and expense as a result of the participation in this event. *
Required
I understand the cost for my child to attend VBS is $15 for the week. Payments may be made online, in person, or by mailing a check to: Tucker First UMC, 5095 LaVista Road, Tucker, GA 30084, ATTN: VBS. *
Required
ELECTRONIC SIGNATURE: I understand that this form is being submitted electronically. Further, I attest that the signature affixed here is that of the person named as the parent or legal guardian of the participant named herein. My signature on this form transmitted in electronic format shall be treated as an original signature in all purposes. I understand that the electronic form is legally binding as if submitted as a physically signed original. I agree to these terms. *
Required
Signature: *
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms