Vacation Bible School June 2-6, 2024 Registration Form 2024 Child's Name First Last Gender Male Female Date of Birth Month Day Year Grade Grade Completed - PS for PreschoolAttend church? Yes No If yes, where? Parent/Guardian Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Preferred Contact NumberText? Yes No Does your child have any food allergies or medical conditions that we need to know about? Yes No If yes, please detail: Participant Agreement By signing below, the participant (or parent/guardian if participant is a minor) acknowledges and accepts the risks of physical injury associated with participation in the activity described above. Except for gross negligence on the part of the sponsor and/or its representatives, including employees, and/or its volunteers, the participant (or parent/guardian) accepts personal financial responsibility for any bodily or personal injury sustained during the activity. Further, the participant (or parent/guardian) promises to hold harmless the sponsor listed above and its representatives, including employees, and its volunteers, for any injury related to the activity. If a dispute over this agreement or any claim for damages arises, the participant (or parent/guardian) agrees to resolve the matter through a mutually accepted arbitration process.Consent I agree that my typed signature can serve as a substitute for my handwritten signature.Signature Participant or parent/guardian if minorDate Month Day Year Photographs As parent/guardian of participant, I, the undersigned, allow image(s) of my child to be taken and used in promotion and publicity.Photographs I agree that my typed signature can serve as a substitute for my handwritten signature.Signature of Parent/Guardian Date Month Day Year EmailThis field is for validation purposes and should be left unchanged. Δ