Registration for children Ages 4 through Grade 6 Please enable JavaScript in your browser to complete this form.FAMILY NAME: *FAMILY CHURCH *MOTHER'S NAME *FATHER'S NAME *Email *Primary Phone Contact: *Alternate Phone:FIRST CHILD'S NAME *Child's Age *Grade Completed *Allergies *YesNoGender *MaleFemaleSECOND CHILD'S NAMEChild's AgeGrade CompletedAllergies YesNoGender MaleFemaleTHIRD CHILD'S NAMEAgeGrade CompletedAllergies YesNoGender MaleFemaleNames of anyone picking up child/children other than Mother/Father listed above (child will only be released to individuals listed) *List any allergies or other issues staff should be aware of in caring for your child/children: *LIABILITY RELEASE: By choosing “yes”, this serves as my electronic signature, and I the undersigned in consideration of Faith Lutheran Church allowing the children listed above to participate in VBS, I, do hereby release, forever discharge and agree to hold harmless Faith Lutheran Church, its pastors, directors, employees, volunteers and teachers (collectively herein the “Church”) from any and all liability, claims or demands for accidental personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and my child/children while involved in the children’s ministry activities. I, the parent or legal guardian of this child/children hereby grant my permission for them to participate fully in children’s ministry activities, Furthermore, I, on behalf of my minor child/children, hereby assume all risk of accidental personal injury, sickness, death, damage and expense as a result of participation in these activities. *YesNoMEDICAL TREATMENT PERMISSION: By choosing “yes” I authorize an adult, in whose care the minor has been entrusted, to consent to any emergency medical care to be rendered to the minor/s listed above. The undersigned shall be liable and agrees to pay all costs and expenses incurred in connection with such emergency medical care. *YesNoFREEDOM OF INFORMATION & PRIVACY CONSENT By choosing “yes” I consent to pictures of my child/children being used for the purposes of display or event advertising in print and /or social media by Faith Lutheran Church *YesNoA wet signature will be required on arrival to confirm the accuracy of the information contained in this form. *I AcknowledgeSubmit
