VBS 2023 Registration

Parent's Name

Address

This address will receive a confirmation email

Phone

In case of emergency contact (name of emergency contact)

Relationship to VBS participant

Emergency contact phone number

Church Affiliation

How did you hear about VBS at Westminster? (check one)

Church Friend Road Sign Website Other

Liability Release

In the event of an emergency, I, the undersigned parent/guardian, understand that all will be done to contact me or the emergency contact named above. However, if neither can be reached, we give full permission to a representative of Westminster Presbyterian Church to seek medical attention in my absence for any child registered on this form. I, the undersigned parent/guardian, hereby assume all risk, known or unknown, for any child registered on this form, in connection with their attendance and participation in Vacation Bible School at the Westminster Presbyterian Church VBS event. I acknowledge that participation in Vacation Bible School at the Westminster Presbyterian Church VBS event is voluntary and therefore FULLY RELEASE and discharge Westminster Presbyterian Church, its pastors, employees, directors, and volunteer workers, from any and all liability in connection with any activities carried on at the Westminster Presbyterian Church event in the Vacation Bible School program.

Parent/Guardian Signature (by typing your name in this space, you agree with the statement above.)

Photography/Video Authorization Release

I, the undersigned, also acknowledge that any child registered on this form, as a participant in Vacation Bible School at the Westminster Presbyterian Church event, may be photographed or captured on video during the Vacation Bible School program and activities. I hereby grant full permission to Westminster Presbyterian Church to use photographs or videos—in print, electronic, online, or other public media—of any child registered on this form and further release Westminster Presbyterian Church from any and all liability connected with the authorized use of words and image of any child registered on this form.

Parent/Guardian Signature (by typing your name in this space, you agree with the statement above.)

Well-Child Policy

Each parent agrees to:
We ask that children and workers remain at home with any of the following symptoms/illnesses:

Persistent Cough
Conjunctivitis (pink eye)
Rash
Chills or Fever > 100.4 within the last 48 hours
Runny nose (clear drainage is allowed but reasonably discouraged)
Vomiting (within the past 2 days)
Lice
Diarrhea (for any reason)
Infection of any type
New loss of taste or smell
Shortness of breath or difficulty breathing
Sore Throat
Muscle or body aches

If any of these symptoms are noticed in a child, that child will be unable to stay in the classroom. If the child is already in the room, we will call you to come and pick up your child. If your child has a continually clear, runny nose or rash due to non-contagious allergies, please let our volunteers know at drop off.

Parent/Guardian Signature (by typing your name in this space, you have read and understand the well-child policy)

Child's Information

Children must be at least 5 years of age or older before the first day of VBS, no exceptions. Thank you for your cooperation.

Multiple children may be registered on this form only if each child listed fully matches ALL of the information completed above. Fill out a separate registration for children who do not match this information in entirety.

Child #1

Child # 1: Name

Child # 1: Gender

Child # 1: Birthday

Child # 1: Age

Child #1: Last Grade Completed by July 23, 2023:

Child # 1: School

Child # 1: Allergies/medical conditions/exceptionalities/activity restrictions.etc.

Child # 1: Please describe your child’s reactions to the food allergen you have listed. (i.e anaphylaxis, nausea, vomiting, difficulty breathing, hives, etc.)

Please describe learning, emotional, or behavioral needs below.

If your child is bringing a guest or would like to be with a specific friend, please provide the name in the box below. We will try to accommodate everyone’s wishes, but this is not guaranteed. Children more than 1 grade level apart will not be placed together, and the older child will be placed in the younger child’s class. Thank you for your understanding. Guests and friends must complete a separate registration form that includes your child’s name by July 14 in order to be placed together.

Child #2

Child # 2: Name

Child # 2: Gender

Child # 2: Birthday

Child # 2: Age

Child #2: Last Grade Completed by July 23, 2023:

Child # 2: School

Child # 2: Allergies/medical conditions/exceptionalities/activity restrictions.etc.

Child # 2: Please describe your child’s reactions to the food allergen you have listed. (i.e anaphylaxis, nausea, vomiting, difficulty breathing, hives, etc.)

Please describe learning, emotional, or behavioral needs below.

Child #3

Child # 3: Name

Child # 3: Gender

Child # 3: Birthday

Child # 3: Age

Child # 3: School

Child #3: Last Grade Completed by July 23, 2023:

Child # 3: Allergies/medical conditions/exceptionalities/activity restrictions, etc

Child # 3: Please describe your child’s reactions to the food allergen you have listed. (i.e anaphylaxis, nausea, vomiting, difficulty breathing, hives, etc.)

Please describe learning, emotional, or behavioral needs below.

Child #4

Child # 4: Name

Child # 4: Gender

Child # 4: Birthday

Child # 4 Age

Child # 4: School

Child #4: Last Grade Completed by July 23, 2023:

Child # 4: Allergies/medical conditions/exceptionalities/activity restrictions. etc:

Child # 4: Please describe your child’s reactions to the food allergen you have listed. (i.e anaphylaxis, nausea, vomiting, difficulty breathing, hives, etc.)

Please describe learning, emotional, or behavioral needs below.

Before clicking the "submit" button, please review all information to ensure it is correct, especially WHEN USING AUTO-FILL.

VBS 2023 Registration

Description

Please Fix the Following