VBS Registration

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    Parent's First and Last Name (Or Legal Guardian)*

    Transportation Needed?

    Email Address

    Phone*

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    Street Address*

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    Children Information (Name, age and grade, Medical, Allergy or Dietary Concerns) or comments:

    Agreement: By my signature below, I acknowledge and accept the risks of physical injury associated with participation in all games and activities. I accept personal financial responsibility for any injury or illness stemming from this Day Camp and further, will hold harmless Mt. Zion Baptist Church or any of their representatives for any injury or illness stemming from VBS. This includes any illness or injury due to the current Coronavirus situation. I agree that I am aware of the risks associated with the current Coronavirus situation, and I agree that my children are participating in this activity at their own risk. I understand that Mt. Zion Baptist Church of Brogue, PA, will not participate in any form of “contact tracing.”
    Disclaimer: For the health and safety of all participants, Mt. Zion Baptist Church Camp requests that people with contagious conditions or diseases not participate in this VBS. Furthermore, if any potential attendee has had any illness in the two weeks prior to this VBS, we request that this potential attendee not participate in this VBS. We appreciate your cooperation and understanding in this matter of public health. Parents will be notified in the event of a medical situation. In case of a medical emergency, I understand that every effort will be made to contact me or another emergency contact. In the event I or the contact(s) cannot be reached, I hereby give permission to the Physician selected by the VBS Director to hospitalize, secure proper treatment, order injection, anesthetize, or perform surgery deemed necessary for my children. I agree to all the statements in this agreement and disclaimer.