Vacation Bible School

Volunteers, sign up here!

WONDER VBS 2020 Registration Form

Grown-ups, please complete one form for each child attending VBS.

* Indicates required field

Child's Name *

First

Last

Parent/Guardian Name *

First

Last

Email *

Primary Phone Number *

Secondary Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Emergency Contact Name and Phone *

Special Needs/Allergies *

Who may pick up this child from VBS? *

Health Release

By my signature below, I consent to any ex-ray, examination, anesthetic, medical, dental, or surgical diagnosis or treatment and hospital care under the general supervision and upon the advice of or to be rendered by a physician, surgeon, and dentist licensed under the Medical Practice Act and Dental Practice Act. As parent or legal guardian, I am responsible for the health care decisions of my child and am authorized to consent to services to be rendered, and no other consent is required by law. I hereby give permission to the physician selected by the activities supervisory personnel then present to render medical treatment deemed necessary and appropriate by the physician or dentist. I will assume FULL FINANCIAL RESPONSIBILITY for care given.

I warrant and represent that I am eighteen years of age or over, and am fully aware of and understand the terms and legal consequences of the signing of this form. I intend my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law.

Parent/Guardian Signature *

Date Signed *

VBS Participant Covenant

Grown-ups, please review the following with your child...

As a participant in VBS, and as a child of God, I understand and agree to the following expectations:

I will choose to participate fully in Day Camp
I will choose to respect all people, including myself, choosing to treat others as I would like to be treated.
I will choose to listen to all leaders and volunteers.
I will choose to use my words to build others up, or I will choose to be quiet.
I will not bring harm to myself or others. I will choose to maintain self-control.
I will choose to be respectful of the facilities and grounds where VBS is held. I understand that if I damage other people’s property, I am responsible for replacing/repairing it.

I understand that if I choose to break this covenant, there are consequences. I will take responsibility for my actions. I understand that if I choose to harm myself or others, my parent/guardian will be contacted and I will be sent home.

Child's Signature *

I have read this covenant and enter into it with my child. I will encourage my child to abide by it daily. I understand that should my child choose to break this covenant, every effort will be made to contact me and my child will be sent home. I also understand that if I am not reachable the emergency contact listed will be contacted.

Parent/Guardian Signature *

Submit

WONDER VBS 2020 Registration Form

Health Release

VBS Participant Covenant

First Lutheran Church

1000 3rd Ave. SE, Cedar Rapids, IA | 319.365.1494 | info@firstlutherancr.org | A congregation of the ELCA

Office Hours: Mon. -Thurs. 8 a.m. - 5 p.m. ; Fri. 8 a.m. - 4 p.m.

WONDER VBS 2020 Registration Form

Health Release

VBS Participant Covenant

First Lutheran Church

1000 3rd Ave. SE, Cedar Rapids, IA | 319.365.1494 | info@firstlutherancr.org | A congregation of the ELCAOffice Hours: Mon. -Thurs. 8 a.m. - 5 p.m. ; Fri. 8 a.m. - 4 p.m.

1000 3rd Ave. SE, Cedar Rapids, IA | 319.365.1494 | info@firstlutherancr.org | A congregation of the ELCA

Office Hours: Mon. -Thurs. 8 a.m. - 5 p.m. ; Fri. 8 a.m. - 4 p.m.