VBS 2019 : Registration Form
Escape to Athens With Paul!
Imagine leaving a life of privilege and power to face angry mobs, painful imprisonment, and chain-breaking earthquakes—all to spread the life-changing truth of God’s love. Learn the jaw-dropping story of the Apostle Paul…straight from Paul himself! In an ancient “anything goes” culture, Paul will inspire kids to share the truth of God’s immeasurable love today!

When:
June 27 – 29, 2019

Thursday : 6 – 9 PM
Friday : 6 – 9 PM
Saturday : 10 AM – 2:30 PM

Where:
New Life Mission Church of Northern California
1325 Dry Creek Road, San Jose, CA 95125
http://www.newlifenorcal.org/

Who:
Pre-K (Age 2 : In order to better assist your child’s needs, we kindly ask that a parent/guardian be present in all classes and activities.)
Pre-K (Age 3)
Pre-K (Age 4)
Pre-K (Age 5)
Kindergarten (Completed)
1st – 5th Grade (Completed)

Registration Fee:
$25.00 for the first student, $10.00 for each additional siblings. Please make your payments to NLMC of NC. Your registration fees are due on the first day of VBS, 6/27. For more information or questions, please contact us at vbs@nlmc.org.

Student Information
Student's First Name *
First Name
Your answer
Student's Last Name *
Last Name
Your answer
T-shirt Size (T-shirts are in youth size) *
Age or Grade Completed *
Age of the student on the first day of VBS or grade completed
Medical Insurance *
Insurance Provider and Policy Number
Your answer
Allergies / Medical Conditions *
If the student has any special medical needs, please list them in detail. In particular, if the student has any food allergies, please list them in detail below. This information is essential in catering food and snacks to the student's needs.
Your answer
Parent/Guardian Information
Parent / Guardian Full Name *
Your answer
Home Address
Your answer
Phone Number *
In case of emergency, we will be contacting via this phone number.
Your answer
Email Address *
Your answer
Home Church
Your answer
Terms and Conditions
PHOTOGRAPH AND FILM RELEASE *
I hereby grant to New Life Mission Church of Northern California (NLMC of NC) the right to photograph, film or videotape my dependent and use the photograph and or other digital reproduction of him/her or other reproduction of his/her physical likeness for publication processes, whether electronic, print, digital or electronic publishing via the Internet. I waive the right to inspect or approve the finished version(s) of such images including written copy that may be created in connection therewith.
Required
RELEASE OF ALL CLAIMS, WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNIFICATION AGREEMENT *
In Consideration of New Life Mission Church of Northern California (NLMC of NC) organizing, arranging and permitting me to attend and participate in the event described above and any related activity, I hereby waive all rights which I may now have or which may accrue in the future against NLMC of NC its respective directors, officers, employees, and members (collectively the "NLMC of NC Representatives", and I hereby release and discharge NLMC of NC and the NLMC of NC Representatives from all liability, and agree to indemnify and hold NLMC of NC and the NLMC of NC Representatives harmless from and against all liability for any and all actions, damages, causes of action, suits, costs, losses, expenses, claims, demands, damages, and judgments (collectively the "Losses and Claims"), which I, my spouse, family members, children, invitees, heirs, executors, administrators, successors and assignees, now have or hereafter may have resulting from or arising in connection with my travel to, attendance at or participation in the NLMC of NC event or related activity. I acknowledge that certain legal rights against NLMC of NC or the NLMC of NC Representatives may be available to me now or in the future as a result of any Losses and Claims, and that by executing this waiver and release of liability, my spouse and I are forever relinquishing those rights against NLMC of NC and the NLMC of NC representatives. I acknowledge that no promises, representations, or affirmations of fact were made to me by NLMC of NC or the NLMC of NC Representatives concerning the safety of the event or related activity, the security precautions taken in sponsoring the event, the relative safety or danger associated with traveling to the event or participating in any activity or outing related to, or connected in any way to the event and affirm that I have read and understand the forgoing provisions of this waiver and release of liability, assumption of risk and indemnification agreement and accept it's terms as a condition to my attendance at the event.
Required
Entering your full name in the box below, you are effectively providing your signature, agreeing to the waiver. *
Your answer
ADULT AUTHORIZATION AND CONSENT TO EMERGENCY MEDICAL TREATMENT *
In case of a medical emergency, I hereby give NLMC of NC Representatives permission to authorize emergency medical care by a physician as he or she may deem necessary.
Required
Entering your full name in the box below, you are effectively providing your signature, agreeing to the authorization and consent. *
Your answer
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