Toledo Chinese Alliance Church 2018 VBS Registration Form
Dates: 7/30/2018 – 8/3/2018
Check in at 6:30pm
Program Time: 6:40 -8:45pm
Applied to children ages 3 and up to entering 6 grade
One form per family
Parent/Guardian Name *
Your answer
Address *
Your answer
Phone Number *
Your answer
Email Address *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
Registering Child #1 Name *
Your answer
Child #1 Date of Birth *
Your answer
Child #1 Entering Grade (Fall 2018) *
Child #1 Medical Info or Food allergies *
Your answer
Registering Child #2 Name
Your answer
Child #2 Date of Birth
Your answer
Child #2 Entering Grade (Fall 2018)
Child #2 Medical Info or Food allergies
Your answer
Registering Child #3 Name
Your answer
Child #3 Date of Birth
Your answer
Child #3 Entering Grade (Fall 2018)
Child #3 Medical Info or Food allergies
Your answer
Registering Child #4 Name
Your answer
Child #4 Date of Birth
Your answer
Child #4 Entering Grade (Fall 2018)
Child #4 Medical Info or Food allergies
Your answer
Additional information about your child(ren) that you would like us to know
Your answer
Allow pictures of your child(ren) above to be used in our VBS slide show and other promotional media? *
Do you attend church?
If so, which church do you attend?
Your answer
My child(ren) will be picked up each day by *
Your answer
Relationship to the child(ren) (of above) *
Your answer
Release of Liability: By signing below, I expressly warrant that the child(ren) named above is(are) capable of withstanding both the physical and mental demands of VBS activities. I also assume all risks of the child(ren) participating in the activities, whether such risks are known or unknown to me at this time. I recognize that there may be an occasion where the child(ren) named above may need first aid or emergency medical treatment as a result of an accident, illness, or other health condition or injury. I do hereby give permission for agents of the Toledo Chinese Alliance Church to seek and secure any needed medical attention or treatment for the child(ren) including hospitalization, in the event of an emergency. In doing so, I agree to pay all fees and costs arising from this action to obtain medical treatment. I give permission for attending physician(s) and other medical personnel to administer any needed medical treatment, including surgery, and, again, I agree to pay for the medical treatment. Parent/ Guardian Signature *
Your answer
By typing your name above, you are signing this registration form electronically. You agree your electronic signature is the legal equivalent of your manual signature on this registration form.
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