2023 July 10-13 VBS Registration

Child's Name

Grade in September

Child's Birthday

Parent Name(s)

Street Address

Phone

Parent Email

This address will receive a confirmation email

In case of emergency contact:

Emergency Contact's Relationship to child:

Emergency Contact Phone:

Allergies, medical conditions, or special needs:

Names of adults with permission to pickup child:

Sibling(s) Attending

Do you have a friend attending and would like to be in the same group? Let us know their name, we will try to place you in the same group.

Shirt size

LIABILITY RELEASE: In consideration of Pilgrim Lutheran Church (PLC) allowing the Participant to participate, I, the undersigned, do hereby release, forever discharge and agree to hold harmless PLC, its pastors, directors, employees, volunteers and teachers (collectively herein the “Church”) from any and all liability, claims or demands for accidental personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the Participant while involved in this event away from church premises. My youth and I hereby waive any claims I may have and release PLC and its employees from liability of claims arising out of such activities. I have read the above and fully understand its contents and understand this agreement does not expire. I consent to my youth participating in this event.

Agree

PLC Photo Release Form for Children and Youth: I understand that Pilgrim Lutheran Church (PLC) is a public area and my minor participant may be photographed, interviewed, and/or videotaped by representatives of PLC and/or media outlets (newspapers, T.V. stations, etc.). I also agree that PLC may photograph and record my child/dependent’s likeness and activities during any church-related activities, even if off-site. PLC uses photos of children, youth & families in congregational publications to share information about Pilgrim. Any images obtained may be reproduced by Pilgrim and/or public media for use in advertising, publicity, and/or educational activities. PLC’s publications include, but are not limited to: the website, social media (Facebook, Instagram, Twitter, etc.), advertisements, annual reports, posters, banners, bulletin boards, and other public relations materials. My youth and I hereby waive any claims I may have and release PLC and its employees from liability of claims arising out of such activities. I have read the above and fully understand its contents and understand this agreement does not expire. I consent to my youth participating in this event.

Agree Please do not share photos of my child's face.

2023 July 10-13 VBS Registration

Description

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