2016 Vacation Bible School Registration Form Tuesday, June 28

2016 Vacation Bible School
Registration Form
Tuesday, June 28 from 9-11:30am
Tuesday, July 26 from 9-11:30am
Tuesday, August 9, from 9-11:30am
A place of
work  witness
welcome  worship
One form per family! (If possible)
Please fill out both sides of this form!
$5 Registration fee for each child.
Name & age of Child(ren):___________________________________________________________
Grades entering fall 2016 ____________________________________________________________
Street Address: ________________________________________________________________________________
Zip: ______________________________________
Parent or legal guardian_____________________________________________________________
Home E-Mail Address: _______________________________________________________________________
Contact Telephone: Mom’s Cell_________________________Dad’s Cell ___________________________
Other (please note relationship to child___________________________________________
Emergency contact (other than parent) ________________________________________________
Relationship to child ____________________________ cell phone #___________________
Allergies or other medical concerns:
Dates your child(ren) will attend: June 28 _______ July 26 _______ August 9 ______
Other information you would like us to know ___________________________________________
The Family VBS Festival will take place on Saturday, August 13, from 4-7 pm in the
Great Room. This learning event for the whole family will include dinner. Please
indicate the number of family members who will be attending this Festival ________.
Please return this form to First Presbyterian Church, 2330 South Main Street, Findlay, Ohio 45840-1146.
If you have any questions, please feel free to contact Beth Niemeyer, VBS Director 419-423-9308.
First Presbyterian Church Liability Release Statement
2016 Vacation Bible School
In consideration of the acceptance of my child or ward to participate in the activities sponsored by The First
Presbyterian Church of Findlay, Ohio, I/we, for myself and for my child or ward and his or her executors,
administrators, heirs, and assigns, do hereby release, discharge, indemnify and save and hold harmless The First
Presbyterian Church, Findlay, Ohio, its trustees, session members, elders, ministers, members, agents, employees,
volunteers, supervisors of the activity and associated functions, providers of transportation and those in any way
associated therewith, whether individually or jointly and severally from and against any and all claims, suits, damages,
demands, actions, liabilities, losses or expenses whatsoever may arrive at any time from said child’s or ward’s
participation in such activity to include but not limited to injuries sustained during the activity or associated functions.
In the event that reasonable attempts to contact me/us have been unsuccessful,
(1) I hereby give my consent for the adult leaders of First Presbyterian Church to sign for emergency care for my
child as deemed necessary by a licensed physician or dentist.
(2) I authorize the transfer of my child to any hospital that is reasonably accessible. This authorization does not
cover surgery unless deemed necessary by two physicians or dentists PRIOR to the performance of such
surgery. Should it be necessary for the child to return home due to medical reasons or otherwise, the
undersigned shall assume all transportation costs.
(3) The undersigned gives permission of this child to ride in any vehicle designated by the adult in whose care the
minor has been entrusted while attending and participating in activities at First Presbyterian Church.
(4) Should this child injure self, others, or damage property of the Church, its agents, representative, or others, the
undersigned hereby agrees to pay all damages required to save, hold harmless and indemnify First Presbyterian
Church, its agents, representatives and those injured or damaged from all cost, claims, suits, damages,
demands, actions, liabilities and losses whatsoever it or they may sustain as a result of the negligent, willful or
intentional acts of this child.
I, the parent or legal guardian of my son and/or daughter: (children’s names)
Hereby give my consent to the use of any video images, photographs, audio recordings, or any other
visual or audio reproduction that may be taken of the children during the activities attended by them
to be used, distributed, or shown as the church deems appropriate.
Printed name of Parent/Legal Guardian______________________________________