Vacation Bible School Registration
 Name of Parish: St. Andrew (675 Riverside Rd. Roswell, GA 30075)                                                                              

PARENTAL CONSENT AND EMERGENCY MEDICAL RELEASE FORM

 Vacation Bible School is June 2-6 from 9 AM to Noon every day. It is open to children ages 3-11 (5th grade), but we need middle school and high school volunteers as well. You do not need to be a parishioner or involved in our faith formation program to attend. All children are welcome! Please register by May 18th so we can ensure we have enough materials. The registration fee for Vacation Bible School is $50 per child, max $125 per family.

I/We the parent(s) of:                                                                                   do hereby give my/our approval for him/her to participate with the Vacation Bible School that is sponsored by St. Andrew. I/We do hereby, for myself, my heirs, executors, and administrators, waive, release, absolve, indemnify and agree to hold harmless any and all adults who chaperone, also the Archdioceseand its representatives, successors, supervisors, sponsors, organizers and participants for any injuries in connection with the program named above. I likewise release from my responsibility any person transporting my child to and from any of the activities. I/We hereby grant permission for publication of group (two or more persons) photos taken at youth events. 

I/We also give permission to seek any emergency care should my child be involved in any accident or be injured in any way during such events named above. I/We understand that in any such instance, all attempts will be made to contact the parent/guardian. In the event that I/we cannot be contacted, I/we hereby give permission to the attending physician to hospitalize, secure treatment for, and to order injection, anesthesia, and/or surgery for my child, as named herein. 

I also agree that I am legally responsible for all/any personal actions taken by my child/guardianship during this event, and agree to be financially responsible for any/all damages, legal fees, and other costs incurred as a result of the actions/behavior of my child/guardianship.

Furthermore, I/we agree that if the above named student’s behavior is inappropriate, unsafe and/or detrimental to the group, I will be contacted immediately to secure means of removing my child/guardianship from the event premises. I understand that any financial costs incurred as a result of my child/guardianship being sent home are my responsibility.

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Please list your children's' names below *
Insurance Carrier
Policy #
Insurance Phone #
Children's Birthdays *
Parent Cell *
Parent Name *
By initialing here, I grant permission for non-prescription medications to be given, if deemed appropriate by adult chaperone(s).
My child is allergic: 
Current medication (and dosage):
Other medical, physical, or general information:
In an emergency, notify (name) *
Emergency contact's phone number: *
Emergency Contact's Relationship to child: *
You will need to sign below at the front office or when you drop off your child. You can make payments to the office or online here https://secure.myvanco.com/L-ZA7P/home :

In signing this form, I certify that all information contained herein is true and accurate to the best of my knowledge.

Name:
Date:
Signature:
Relationship:
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