VBS | South Shore Church

Child Information:

First Name*

Last Name*

Birthdate of Child: Year

Month:

Day

Age of Child:*

Grade Child will complete (or has completed) in June 2024:*

Is there a friend (close in age) that your child would like to be in a group with?

Any Medical or Emotional Needs we should be aware of:

Any Allergies / Special Medicine?

Does the child carry an epipen?*

Yes

No

Where is the epipen located?

Parent / Guardian Information:

Name of Parent(s) / Guardian(s):*

Address*

City*

State/Province*

Zip/Postal Code*

Email Address*

Phone*

Alternate Contact Person:

Alternate Contact Name:

Alternate Contact Phone Number:

PHOTOS:

I Grant Permission for the reasonable use of pictures containing my child in any or all of the following ways:

Brochures (Printed Promotional Material)*

Yes

No

Slide Show during the Church Service (live-streamed on YouTube)*

Yes

No

Newsletter*

Yes

No

Website*

Yes

No

MUST INITIAL THIS SECTION WHEN YOU DROP OFF YOUR CHILD on the first day:

PLEASE NOTE: ON THURSDAY Morning (weather permitting), we will have a bouncy castle set up for the games time: The risk of injury exists in this activity. Due to the very nature of this activities, the risk of injury may increase. Injuries may range from minor sprains to more serious concerns. The safety and well-being of the participant is a prime concern and attempts have been made to manage as effectively as possible, the foreseeable risks inherent in all activities. I also agree that my son or daughter shall be required to follow the rules that apply specifically to this activity, and as explained to him/her by the leader. Participants are expected to be responsible and to behave in a manner that ensures the safety, well-being of themselves and others. As well, he/she shall comply with the leader’s/supervisor’s expectations.

TO BE SIGNED at South Shore when you drop your child off:

Due to the very nature of the games and activities there is a risk of injury. The safety and well-being of the child will be our prime concern. Precautions will be taken for their well-being and protection. I / we the parent(s) or guardian(s) named above, authorize the ministry leader in charge to sign consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures for the participant named above (in the event of an emergency, after attempting to reach the parent). This consent and authorization is effective only when participating in Vacation Bible School, July 24-28, 2023.

VBS Information

VBS 2024 - Breaker Rock Beach

REGISTER YOUR CHILD NOW: