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Scuba VBS Registration Form
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June 24th - 28th 5:30 pm - 8:00 pm 
Child's Name *
Child's age and date of birth *
Name of parent(s) *
Address *
Phone Number *
Email address *
Emergency contact (Name and Phone) *
Food allergies (or note none known) *
Medical Concerns (or note none known) *
Grade completed *
I would like to help!  
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Informed Consent and Acknowledgement I hereby give my approval for my child’s participation in any and all activities prepared by the churches putting on this event during Vacation Bible School. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Stroudsburg UMC, Wooddale UMC, and Analomink UMC. In case of injury to said child, I hereby waive all claims against Stroudsburg UMC, Wooddale UMC and Analomink UMC.                                                                                       Confirmation BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE. *
I grant permission for my child to be photographed or recorded for display, distribution, publication, transmission, or otherwise use of photographs, images and/or video taken of myself or my child for use in materials for purposes of church ministry including but not limited to the church Facebook pages or website. *
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