vbs If you would like to register for VBS, please complete the form below. How many children are you registering for?*How many children are you registering for? * One Two Three Four 1st Child's InformationName* First Last Date of Birth* MM slash DD slash YYYY School Grade* 2nd Child's InformationName* First Last Date of Birth* MM slash DD slash YYYY School Grade* 3rd Child's InformationName* First Last Date of Birth* MM slash DD slash YYYY School Grade* 4th Child's InformationName* First Last Date of Birth* MM slash DD slash YYYY School Grade* Parent InformationName* Phone Number*Email* Address* Street Address Address Line 2 City State State *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 ZIP Code Emergency Contact Name* Emergency Contact Phone Number*Are you a member of the River?*Are you a member of the River? * Yes No How did you hear about Vacation Bible School?*How did you hear about Vacation Bible School? Please tell us below! *Medical Release*Medical Release: If at any time medical or first aid treatment is required due to circumstances such as accident, sudden illness or emergency, I/We authorize that this treatment may be given, including necessary anesthetic, by a private physician or hospital. I/We also consent emergency transportation if necessary. * I do I do not Waiver of Claims*Waiver of Claims: I/We permit the child stated above to take part in Vacation Bible School—to be held at River of Life Fellowship Church (ROLF), and agree to waive any claims upon ROLF (or any of it's Agents) in the event of injury, loss, or damage, (however caused), that may be sustained by the above-mentioned child, while taking part in the programs, and in all matters relating to the ministries organized by ROLF. I/We understand the risks involved in the nature of these programs. * I agree I disagree Photography/Videotaping Release*Photography/Videotaping Release: I hereby give consent for my child to be photographed or videotaped for promotional use by River of Life Fellowship Church. They will not be forwarded to any third party. * I do I do not
