LIALC Children's Breaker Rock Beach VBS
On Monday, August 12 to Friday, August 16, 2024 at 9:00 to 12:30pm, with optional extended hours until 5:00pm. Limited space is available on a first-come-first-serve basis (while we may accept late registrations, supplies are limited.)

One child per registration form. Return a signed LIALC VBS Parental Consent Form on the first day of VBS on Monday, August 12th when your child is checked in. Children without a signed parental consent form will not be accepted. Thank you for your understanding.
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Child's First Name *
Child's Last Name *
Child's Date of Birth *
Child's last grade completed (in school year September 2023-June 2024) *
Mark only one.
Medical information we need to know, including food allergies, medication... *
Home Street Address *
Town *
State and Zip code *
Home Phone Number *
Email *
Name of Primary Guardian and Cell Phone Number *
Name of Secondary Guardian and Cell Phone Number *
Dismissal: Who may pick up your child at the end of each VBS day? *
[Name, Relationship, Phone number}
Will your child enroll in extended care hours between 12:30-5:00pm (following the end of regular VBS at 12:30pm)? [Specify time of pick-up.] *
My child has my permission to participate in the Long Island Abundant Life Church events that are being held on Monday to Friday on August 12, 13, 14, 15, and 16, 2024 at 7-19 East Marie Street and 24 East Nicholai Street, Hicksville NY 11801. I give permission to have my child treated in case of medical emergency. In the event of a medical emergency and I cannot be reached, I hereby authorize LIALC staff or volunteers, and/or emergency and medical personnel to make emergency medical decisions for my child. I understand and hereby agree to assume all of the risks which may be encountered at the activities sponsored by LIALC that my child will be attending pursuant to this consent and release form. I hereby agree to release, defend, indemnify, and hold harmless LIALC and its agents and employees from any and all past, present, and future, known and unknown liabilities, actions, causes of action, claims, expenses, and damages (including without limitation, interest, penalties, court costs, attorney's fees and expenses) resulting from or on account of injury to my child, myself or my property or his/her/their property in connection with any event anticipated by this form. I further release any and all claims brought by or through me, including claims for loss of consortium and all similar claims based on relationships with other people. I expressly agree that this release, waiver, and indemnity agreement is intended to be broad and inclusive as permitted in the State of NEW YORK. and that if any portion thereof is held invalid, it is agreed that the remainder shall, notwithstanding, continue in full legal force and effect. I also agree that any controversy or claim, by or through the party signing this release, arising out of or relating to the activities anticipated by this form shall be settled by binding Christian arbitration conducted by the National Center for Life and Liberty or another Christian arbitrator, and judgment on the award may be entered in any court having jurisdiction thereof. This release contains the entire agreement between the parties hereto and the terms of this release are contractual and not a mere recital. I further state that I have carefully read the forgoing release and know the contents thereof and I sing this release as my own free act. This is a legally binding agreement which I have read and understand.
Our statement of faith does not exhaust the extent of our faith. The Bible itself is the sole and final source of all that we believe. We do believe, however, that the statement of faith accurately represents the teaching of the Bbile and, therefore, is binding upon all members, staff, and volunteers. All literature, whether print or electronic, used in church shall be in complete agreement with the statement of faith. All activities permitted or performed in any facilities owned, rented, or leased by this church or engaged in by any member of the church staff (volunteer or paid) and all decisions of the administration of this church shall not conflict with the statement of faith. In all conflicts regarding interpretation of the statement of faith, the pastor and board, on behalf of the church, have the final authority.
PARENTAL CONSENT: I will provide a signed LIALC VBS Parent Consent Form on the first day of VBS on Monday, August 12th when my child is checked in. *
Check all that apply.
May we have permission to photograph your child for LIALC?
Mark only one.
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Does your child attend church regularly?
What language does your child speak at home?
How did you hear about us?
Would be interested in knowing more about us or the programs we offer?
Thank you for registering your child.
You will receive an email reminder closer to the date.

A freewill offering will be accepted at the offering box by the registration table, or may be mailed to LIALC VBS, 7-19 East Marie Street, Hicksville NY 11801.
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