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COD VBS: The Market Place.. Courageous Faith
June 10-14, 2019 8:45 a.m.-12:15 p.m. Registration is $25 until May 20. $40 starting May 21
Email address *
Child's First Name *
Your answer
Child's Last Name *
Your answer
Child's age during VBS *
Parent/Guardian Name *
Your answer
Relationship to Child *
Your answer
Street Address *
Your answer
City, State, Zip Code *
Your answer
Cell Phone Number *
Your answer
Does your child have any food allergies *
Your answer
Does your child have any medical issues we should be aware of? *
Your answer
What size shirt should we order for child? *
PARENT/GUARDIAN WAIVER: I understand a child who does not abide by the rules of the Church of the Open Door Activities may be dismissed from any and all events. Signature Parent/Guardian on this form waives and releases Church of the Open Door and its workers from liability due to injury or illness incurred at C.O.D. or traveling to and from the church. Participants are responsible for their own property. Church of the Open Door and its workers will not be responsible for lost or stolen items. *
Required
PHOTO RELEASE: I give the Church of the Open Door and its employees and agents the right to photograph my child and use the photo 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 including via the internet. *
AUTHORIZATION TO CONSENT TO TREATMENT OF MINOR: (I) (We), the undersigned, parent(s) of the aforementioned VBS attendant, a minor, do hereby authorize Church of the Open Door and its leaders as agent(s) for the undersigned to consent to any x-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care which is deemed advisable by, and is to be rendered under the general or special supervision of any physician and surgeon licensed under the provisions of the Medicine Practice Act whether such diagnosis or treatment is rendered at the office of said physician or at a hospital. It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care being required but is given to provide authority and power on the part of our aforesaid agent(s) to give specific consent to any and all such diagnosis, treatment or hospital care which the aforementioned physician in the exercise of his best judgment may deem advisable. This authorization is given pursuant to the provisions of Section 25.8 of the Civil Code of California. This authorization shall remain effective until the parent(s) have indicated otherwise in writing to said agent(s). I, the parent/guardian, shall indemnify, hold free and harmless, assume liability for, and defend Church of the Open Door, its agents, servants, employees, officers, and directors from any and all costs and expenses including but not limited to, attorneys’ fees, reasonable investigative and discovery costs, court costs, and all other sums which Church of the Open Door, its agents, servants, employees, officers, and directors may pay or become obligated to pay on account of any, all and every demand for, claim or assertion of liability, or any claim or action founded thereon, arising or alleged to have arisen out of the aforementioned VBS attendee, use of real personal property belonging to Church of the Open Door, its agents, servants, employees, officers and directors, or by any action or omission by the aforementioned VBS attendee. *
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