The Voyage VBS Registration
July 10th-14th, 2016 5:30-8:30pm Highland Baptist Church, Parkesburg PA

Note: Registering online secures your child's spot, however each night they will need to be brought to the Registration tables in the church foyer to be signed in by an adult. You will be required to sign the liability statement at that time.

Name
Your answer
Child's Age
Grade Completed
Parent's Name
Your answer
Emergency Contact Number
Your answer
Email Address
Your answer
Primary Phone
Your answer
Mailing Address
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Church Attending
Your answer
Allergies or Medical Conditions
Your answer
Additional Information
Your answer
I give my permission for basic first aid if necessary. I understand I will be contacted if any further treatment is required.
Required
I give my permission to publish photos containing my child on the church website/facebook page.
Note: children's names will not be identified in pictures.
Medical Release and Liability Agreement- My son/daughter listed above has permission to engage in all activities at Highland Baptist Church from July 10, 2017 until July 14, 2017. In an emergency, if I cannot be reached, I give permission to the Health Officer to secure proper treatment for my child. I, the parent or guardian of the above named individual, acknowledge that participation in indoor/outdoor events necessarily involves risks of physical injury. In consideration for accepting registration of the above named individual , permitting the voluntary participation in the Church's program(s). I hereby release, discharge, and hold harmless Highland Baptist Church, its Pastors, Board of Deacons, Staff Employees, and other Volunteers of the Church from any claims arising out of or relating to any physical injury that may result to said individual while participating in the program(s) on its premise.
This will need a physical signature on the first night of VBS at the Registration tent. I agree to sign the waiver at Registration.
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