Vacation Bible School Registration & Waiver
Vacation Bible School   July 10-13, 2022     Held at the Presbyterian Church of Radford
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Child's Name *
Gender *
Date of Birth *
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DD
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Grade Entering in Fall 2022 *
Required
Parent/Guardian Name(s)
Home Address *
Phone Numbers (Cell, Home, Work, Other) *
Which  church do you attend? Or if visiting with a friend, which is their church? *
Required
Family Physician *
Physician Phone Number *
Does your child have allergies to any medications? Yes or No. If yes, please list. *
Does your child have allergies to any foods? Yes or No. If yes, please list *
Does your child have any other allergies that we should know about? Yes or No. If yes, please list *
Does your child have any medical conditions that we should know about? Yes or No. If yes, please list. *
Does your child have any physical limitations? Yes or No. If yes, please list *
Please describe any other pertinent information we should be aware of to make your child's VBS experience a safe and positive one.
By submitting this form I give permission for my child to participate in Vacation Bible School. I understand that this event will take place under the guidance and direction of volunteers from Grace Episcopal Church, St. Jude Catholic Church and the Presbyterian Church of Radford. I understand that masks will be optional for children and adults while inside the building. As parent/guardian, I remain legally responsible for any personal action taken by my child. I agree to hold harmless the churches listed above, as well as its officers, directors, agents, chaperones or representatives associated with this event, arising from or in connection to my child attending this event, including but not limited to accidents, emergencies, and exposure to reckless conduct of persons.                                        Additionally, by signing my name below, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) may be exposed to or infected by COVID-19 by attending activities at this event. I understand that COVID-19 protocols will be in place and may change based on the level of community transmission at the time of the event.  In case of an emergency, I give permission for my child to receive medical treatment. Typing my name below serves as my signature. *
If I cannot be reached in the case of an emergency please call the person listed below. Name, Phone number and relation. *
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