Care Club Sign-Up 
PLEASE FILL OUT SEPARATE SIGN-UP FORMS FOR EACH CHILD.
Event Timing: Wednesdays beginning September 23rd @ 3:40pm
Event Address: 3950 Leonard St NW, Grand Rapids, MI 49534
Contact Info: pastorjim@onthevinechurch.com

Sign-up ASAP. Space is limited to 30 children so we can maintain the highest level of care and safety for the children. 

If you are unable to use an electronic form, please email pastorjim@onthevinechurch.com .
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Parent/Guardian's 1 Name *
Parent/Guardian 1 Phone
Parent/Guardian's 2 Name *
Parent/Guardian's 2 Phone *
Student's Name- Fill out another form if registering more than one student. Thank you! *
Grade *
Gender *
Birthdate *
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Email Address *
Address *
Phone Number *
Emergency Contact Phone *
Allergies or Special Needs *
Should this child's activities be restricted for any reason? If Yes, please explain. If No, please leave blank.
As the parent or legal guardian of  my child, I hereby give permission for my child to participate in the Vine Church of Walker's Care Club. I understand that Vine Church of Walker is a nonprofit charitable institution, which is voluntarily presenting this program for my child, other participants, and the community. I also understand that the program has activities that can involve physical contact with other participants, the ground or equipment, and that there is a resulting risk of physical injury to my child. *
I have explained these risks and benefits of participating in this program to my child and my child is in proper physical condition and has no existing injuries or conditions that could jeopardize his/her safety or health, or the safety or health of the other participants. I therefore release and discharge all liability for any harm or injury suffered directly or indirectly as a result of my child's participation in the Vine Church of Walker's Care Club and I agree not to sue the Vine Church of Walker, its representatives, staff, or volunteers on any such claim. I also give permission for the staff, representative, or volunteers of the Vine Church of Walker to administer first aid or to seek medical care for my child during my child's participation in the program, including transportation of my child to a medical facility for additional treatment that appears necessary. *
Media Release: I hereby give permission to The Vine Church to photograph my child. I understand the photos may be used in craft projects for your child's home or in The Vine Church publications and/or media without further permission. I understand my child's name will not be used in conjunction with these pictures without further permission. (Please select agree if comfortable. We respect your views and seek to handle this with care. Please visit with us more if you have questions about our use of pictures to share the children's joy's and victories @ The Vine Care Club.) *
Typing your name and dating it in this next box is your digital signature. By doing so, you understand and agree to all of these terms. *
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