CCLW Galactic Starveyors VBS 2017
CCLW VBS
Bill Barber Park, Irvine CA
August 7 - 11
6:00 - 7:30 PM
FREE
calvarylivingword.org
Child Name (First and Last) *
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Child Date of Birth *
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Child Grade *
Allergies *
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Parent or Legal Guardian #1 Name (First Last) *
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Parent or Legal Guardian #1 Email *
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Parent or Legal Guardian #1 Mobile Phone *
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Parent or Legal Guardian #2 Name (First Last)
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Parent or Legal Guardian #2 Mobile Phone
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RELEASE OF LIABILITY & PERMISSION FOR EMERGENCY MEDICAL TREATMENT
I hereby request that my child(ren), be permitted to participate in all activities, to include various outdoor activities. I hereby agree to release Calvary Chapel Living Word, their employees, volunteers, and agents from any and all liability, which may arise from any such activity.

In the event my child becomes ill or injured while participating in activities, and requires medical treatment, permission is hereby given to administer first aid for his/her relief or to obtain whatever medical treatment is necessary, including emergency medical treatment by paramedics.

I understand that Calvary Chapel Living Word cannot be responsible for the supervision of children beyond the scheduled time.

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