VBS 2022 Registration Form
(Please complete this form before arriving at Williamson Rd Church of the Brethren)
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Email *
Child’s Name: *
Date of Birth: *
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DD
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Grade completed in the 2021-22 school year? *
Home Address: *
Home Church: *
Does your child have food allergies? *
If you answered yes to the previous question, please explain here:
Does your child have any medical conditions or allergies that we need to be aware of (i.e. inhaler, epi pen, or diabetes)? *
If you answered yes to the previous question, please explain here:
Parent/Guardian name: *
Parent/Guardian  phone number: *
Will someone other than the parent/guardian be picking up the child? If so, please enter name below.
Emergency contact if parent can not be reached: (Name and number) *
Do you grant permission for us to use photographs and/or videos of your child taken during Vacation Bible School (June 20-22, 2021 at Williamson Rd Church of the Brethren on the churches’ websites, Facebook and in other communications related to this year’s VBS activities.) *
I am fully aware of the inherent risk of in-person activities in the community, including VBS, and will contact the Church immediately if I or anyone in my family show symptoms or test positive for COVID-19 within three (3) days of attending VBS *
 I WAIVE, RELEASE, AND DISCHARGE Williamson Rd Church of the Brethren and their partners from any and all liability, including but not limited to, any injury or sickness resulting from COVID for my child's liability arising from the negligence or fault of Williamson Rd Church of the Brethren, for my child's personal injury, death or disability, or actions of any kind which may hereafter occur to my child while participating in this event. *
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