VBS Registration

Child's Name

Age (As Of June 20th)

Grade In Fall 2024

Gender Gender Male Female

Parent/Legal Guardian's Name

Mailing Address

Phone

Does child have any allergies? Does child have any allergies? Yes No

Transportation Needed Transportation Needed Yes No

If Yes, please provide address of pickup

Agreement: 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 VBS and further, will hold harmless Mt. Zion Baptist Church or any of their representatives for any injury or illness stemming from VBS. I agree that my child is participating in this VBS at their own risk. Agreement: 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 VBS and further, will hold harmless Mt. Zion Baptist Church or any of their representatives for any injury or illness stemming from VBS. I agree that my child is participating in this VBS at their own risk. Agree Disagree

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. 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.

Full Name

Today's Date