Temple's VBS Child Registration Form
Medical Release and Liability:

In the event of sickness or some medical emergency, I, the undersigned parent/ guardian, request my child receive any medical attention or treatment deemed necessary, therefore, I give permission to any hospital, doctor, and/or healthcare provided to transport, treat and/or admit for care of my child. I understand that I am responsible for all expenses and charges for treatment and care of my child. In the event I am not present at the time of the emergency or cannot be contacted, my care as been entrusted to the staff and designated ministry leadership of Temple Church.
Understanding that there is always a possibility that my child my sustain physical illness or injury, I acknowledge and understand that my child is assuming the risk of such physical illness or injury by their participation, and I further release and hold harmless Temple Church and the leaders from liability for any and all claim for personal illness or injury that my child may sustain during "Roar 2019". I further acknowledge and understand that my child will be responsible for their failure to abide by the rules and regulation of "Roar 2019".

By submitting this form, you agree to the medical release & liability terms for "Roar VBS 2019".

Email address *
Child's Name *
Your answer
Child's Gender *
Child's Age *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Grade Entering *
Name of Responsible Guardian *
Your answer
Relation to Child *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Home Phone
Your answer
Responsible Party's Phone *
Your answer
2nd Emergency Contact *
Your answer
Home church
Your answer
Allergies or other medical conditions *
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Temple. Report Abuse - Terms of Service