Summer Jam Registration
July 29 - August 1st, 2019
30 E Main, Hayfield MN 55940
First Child
Child's Name *
Your answer
Grade Entering
Your answer
Food Allergies
Your answer
Medications needed during program
Your answer
Second Child
Second Child's Name
Your answer
Grade Entering
Your answer
Food Allergies
Your answer
Medications needed during program
Your answer
Third Child
Third Child's Name
Your answer
Grade Entering
Your answer
Food Allergies
Your answer
Medications needed during program
Your answer
Adult's Information
Emergency Contact Name *
Your answer
Phone Number *
Your answer
Email address (for daily newsletter)
Your answer
Parent's Name *
Your answer
Phone Number
Your answer
Parent's Name
Your answer
Phone Number
Your answer
Special things we should know about your child(ren)
Your answer
LIABILITY RELEASE I (We) acknowledge that my child’s participation in the Cedar Creek Church youth program is voluntary and may require involvement in activities that require traveling or physical exertion. Such activities may include, but are not limited to: outings, athletic games, local excursions, and meetings. Therefore I (we) waive, release, and discharge from any and all claims or liabilities for death or personal injury damages of any kind, which arise out of or relate to my child’s participation in Cedar Creeks Youth activities, the following person, or entities: Cedar Creek Church, it’s Senior Pastor, youth pastor and any volunteers and representatives of any of the above except in the case of gross negligence on the part of Cedar Creek, Cedar Creek staff or Cedar Creek volunteers. Please check box. : *
Required
I (we) give my permission for the VBS staff to administer basic first aid to my child (named above)in the event of an injury. I understand that the VBS staff will contact emergency services in the event of a significant injury and all expenses for such emergency services will be paid by me. Please checkbox if approve.:
I (we) hereby grant the above named church permission to copyright and use photographs/videos taken at VBS of the minor designated above in any manner or form for any purpose lawful at any time. I waive any right that I may have to inspect or approve the finished product or written copy, that may be used in conjunction therewith, or the use to which it may be applied. Please check box if approve.:
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