2015 VBS at New Vision Church
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Allergies / Medical Conditions
Medical Insurance & Primary Doctor
Parent/Guardian Information
Full Name *
Relationship *
Phone Number *
xxx-xxx-xxxx
Email Address *
Volunteer
Parent volunteers needed for VBS.
Choose one of the following volunteer options listed below: *
Required
Volunteer Name, Email, Phone Number & Other Notes
Payment Information
Payment should be received to complete your registration. Registration Desk will open on 5/3, 5/10, 5/17, 5/31 and 6/7 in the Rodem Fellowship Hall. If you mail a check, please send it to New Vision Church (ATTN VBS) 1201 Montague Expressway, Milpitas, CA 95035. Please make a check payable to New Vision Church and write your child name and birth date on the check.
Registration Fee - $20 until 5/31 and $25 after 5/31, $5 sibling discount may be applied *
VBS T-shirts are not guaranteed for those who register on the day of VBS.
Payment / Cancellation Policy *
Your registration will NOT BE COMPLETED UNTIL YOUR PAYMENT IS MADE. The payment is collected by VBS staffs on behalf of New Vision Church. New Vision Church will not be liable in any way for any loss or damage of any kind incurred as a result of the payment. Refunds will be managed based on receipt of a written request of cancellation. Cancellation until June 7th: registration fees will be refunded the full amount. After June 7th: registration fees will NOT BE REFUNDED.
Required
Terms & Condition
Please read followings carefully. You MUST agree on followings to register.
Photograph and Film Release *
I hereby grant to New vision church the right to photograph, film or videotape my dependent and use the photograph and or other digital reproduction of him/her or other reproduction of his/her physical likeness for publication processes, whether electronic, print, digital or electronic publishing via the Internet. I waive the right to inspect or approve the finished version(s) of such images including written copy that may be created in connection therewith.
Required
Liability Waiver *
I, as the parent or legal guardian of the above-named participant(s), hereby absolve New vision Church and their employees, officers, and activity instructors and assistants harmless from all liability which may arise as a result from the above minor's participation in the class. I understand that the above named activities may involve accidental injury and hereby voluntarily assume such risks. In case of an accident or severe sickness, I authorize New Vision Church to arrange transportation to the nearest possible emergency room or urgent care clinic and to arrange for the appropriate medical or surgical care.   In case of an accident or severe sickness, New Vision Church will attempt to contact me at the home and cell/emergency phone numbers. If such an accident or severe sickness occurs, and New Vision Church is unable to contact me, the uninsured responsibility and expense of this service will be accepted by me.
Required
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