Vacation Bible School (VBS) Registration - First and Wesley United Methodist Church

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Student Information

First Name *

Last Name *

Birth Date *

Age *

School Grade Completed as of July 1, 2024 *

Please list all medical conditions limiting child’s activity (i.e. food allergies, medication allergies, and physical limitations).

Special Needs / Allergies / Medical Information / Other

Parent / Guardian Information

First Name *

Last Name *

First Name

Last Name

Phone (Main) *

Phone (Mobile)

Phone (Work)

Email *

Address *

Home Church (if any)

Friends of your child at this church

Emergency Contacts

First Name *

Last Name *

Phone *

First Name *

Last Name *

Phone *

Additional Information

Dismissal Info *

Please list all persons and their relationship who may pick up your child: Name/ Phone number / Relationship to child

Photography / Video Authorization and Liability Release

In consideration for permitting my child to enroll and participate Sunday School provided by First & Wesley United Methodist Church (“FWUMC”), I, being 18 years or older, do for myself and on behalf of my child, agree and promise as follows:

Authorization

Please read below and check the appropriate box *

I(we) am(are) the parent(s) or legal guardian(s) of the student listed above and grant my(our) permission for him/her to participate fully in VBS activities.

I(we) understand FWUMC staff, volunteers, and leaders will make every attempt to contact me (us) as soon as possible in the event an emergency arises. If I(we) cannot be reached, I(we) authorize FWUMC staff, volunteers, and leaders to take my child to the doctor or hospital. I(we) also authorize medical treatment recommended by medical staff and I(we) assume responsibility for all medical bills.

I(we) understand that my(our) child may be photographed or videotaped during activities and that these photos/videos may be used in promotional materials, including print, online, presentations, websites, and social media, published by FWUMC.

Liability Waiver, Covenant to Hold Harmless & Indemnify

Please read below and check the appropriate box *

I(we), on behalf of my(our) child, assume the risk and promise to release, forever discharge and hold harmless FWUMC, Children’s Ministries, its directors, staff and volunteer leaders from any and all liability for personal injury or sickness and damage to personal or public property which might result from my(our) child’s participation in any and all church activities, including being transported in church, chartered, and chaperone vehicles, to and from the event destination(s). This covenant to hold harmless extends to my(our) child’s participation in any events and activities.

I(we) agree to indemnify and hold harmless FWUMC, its directors, staff, and volunteers for any liability incurred or property damage/loss sustained by FWUMC as the result of the negligent, willful, or intentional conduct of my child, including expenses attendant thereto.

I(we) hereby certify that I(we) have read and clearly understand these terms and that this authorization/waiver/covenant is being executed voluntarily.

Parent / Legal Guardian's Signature *

Date: July 7-11, 2024
Ages: Kindergarten to 8th Grade
Location: First & Wesley United Methodist Church