Game Controller

2017 VBS Registration – “Gideon’s Game Zone”

June 26-30, 6:00 pm – 8:00 pm

Frederick Street Campus

Preschool: 3–5 yrs old and Elementary K – 5th grade

 

 

Child's Name (required):


Please choose one:


Child's DOB:


Address:


City:


State:


Zip:


Phone:


Email:


Child's grade just completed:


Who will be responsible for signing the child out at the end of each session?

Name:

Relation to child:


Please provide an Emergency Contact who will be available during VBS:

Name:

Relation to child:

Home Phone:

Cell Phone:


Are there any medical conditions/allergies we should be aware of?

If yes, please explain (allergies, medications, etc.)


The undersigned gives permission to his/her child to participate in the above named activity and releases First United Methodist Church, its officers, employees and agents from any liability whatsoever for any injury or death to person or loss or damage to property sustained by the undersigned for any member of his family, in attendance, and the undersigned agrees to defend and indemnify First United Methodist Church, its officers, employees, and agents from any liability or loss they might sustain by reason thereof. In the event I cannot be reached in an EMERGENCY, I hereby give permission to the physician selected by the Director of Children’s Ministry to hospitalize, secure proper treatment for, and order injection, anesthesia, or surgery for my child as named above.

Signed: Date:


By signing this registration form, you agree that any photographs or video taken of your child at or during this event are the property of First United Methodist Church and may be used in future publications as deemed appropriate.


If you have any questions or concerns, please contact
Jackie Spadt
Children's Ministries
jackie.spadt@firstumchanover.org
(717) 781-2675