Kingdom Quest VBS

Kingdom Quest VBS Registration

August 22-26, 9am-noon, FREE

Kingdom Quest VBS Registration *

There are currently no events available for registration.

Child's First Name *

Date of Birth (mm/dd/yy) *

City *

Email Address *

Mobile Number *

Child's Last Name *

Home Address *

Postal Code *

Phone Number *

Family Doctor *

Drug Allergy *

YES

Food Allergy *

YES

Will you/your child be carrying an Epi-Pen? *

YES

Office Tel. No *

If yes, what is your child allergic to?

Other Health-Related Concerns *

Emergency Contact (first and last name) *

Emergency Tel. Nos. (Cell/Work/Home): *

Relationship to your child *

Emergency Tel. Nos. (Cell/Work/Home): *

Authorization to Participate

This form allows the child named to attend and participate in all VBS activities sponsored by Trinity Pentecostal Church.

My (electronic) signature on this form is my certification taht the above child is physically capable of engaging in the activities described above, and I hereby give consent for my child to engage in the same. In exchange for allowing my child to participate in this church-sponsored activity, I hereby assume all risks of injury or damages of whatever type or form associated with my child's participation in these activities. I further agree to indemnify and hold harmless Trinity Pentecostal Church from any and all claims arising from any injury or illness of my child during such activities.

Signature of Parent of Legal Guardian (if under 18 yrs of age) *

Date *

Trinity Pentecostal Church may capture event photography and video footage throught activities. These may be displayed around the church or on the church website/Facebook page.

My child may be photographed or recorded and used in accordance with the description provided. *

YES

Signature of Parent of Legal Guardian (if under 18 yrs of age) *

Date *