Mission Liberty Hill Lutheran Church VBS
June 10-13, 2019

A free, light meal will be served from 5-5:30. We ask that if you would like to come for the meal, that you would stay with your child until we start the VBS program at 5:30 pm. VBS will conclude at 7:00 pm.

**Please fill out a form for each participant that plans to attend VBS! Thanks!

VBS Participant First Name *
Your answer
VBS Participant Last Name *
Your answer
VBS Participant Mailing Address (please include street address as well as city and zip code) *
Your answer
VBS Participant Grade Completed 2018-2019 School Year *
Days your child will be able to attend... *
Required
Contact email address *
Your answer
Contact Cell Phone Number *
Your answer
May we text you if we need to reach you regarding updates and information? *
Does your child have any allergies we should be aware of? Please explain. *
Your answer
Emergency Contact #1 Name (First/Last Name) *
Your answer
Emergency Contact #1 Relation to Child *
Your answer
Emergency Contact #1 Phone Number *
Your answer
Emergency Contact #2 Name (First/Last Name) *
Your answer
Emergency Contact #2 Relation to Child *
Your answer
Emergency Contact #2 Phone Number *
Your answer
Home Church *
Your answer
Photo Release: We will be taking photographs of various activities and events during Vacation Bible School. These photos may be displayed on the church's website, Facebook page, monthly newsletter, bulletin board, and local and synodical newspaper. We will not publicize photos of your children without your consent. Please complete the form below, indicating your preference. Your child’s name will not be published with the photograph. *
I/We, the undersigned, are the parent(s)/legal guardian of the above named child and we agree, to release and hold harmless Mission Liberty Hill Lutheran Church from any and all claims, demands, suits, cost, and charges in connection with or arising out of the child care service, including, but not limited to, bodily harm or injury to our children, except only for loss, harms or injury occasioned by gross negligence or intentional misconduct by Mission Liberty Hill. I hereby grant permission for Mission Liberty Hill and its employees and volunteers full authority to take whatever actions they deem necessary regarding my child’s health and safety in the event I cannot be reached or in the situation where time is of the essence; and fully release Mission Liberty Hill Lutheran Church and its employees and volunteers from any liability in connection with those decisions, I grant permission for emergency treatment by a rescue squad, private physician and/or hospital or emergency health care facility staff if needed. Any such action will be taken in the best interest of my child and will be reported to me as soon as possible. I HAVE READ AND UNDERSTAND THIS ON-SITE CONSENT AND WAIVER FORM AND SIGN VOLUNTARILY AND ENTIRELY OF MY OWN FREE WILL. *
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Mission Liberty Hill Lutheran Church. Report Abuse - Terms of Service