Child's First and Last Name
Child's Date Of Birth (must be 3yrs by 7/1/24)
My child will attend VBS on the following days?
It is OK if plans change!
Parent/Guardian First & Last Name
Mobile Phone
Email
If Parent/Guardian cannnot be reached
Emergency Contact First & Last Name
Emergency Contact Mobile Phone
Emergency Contact Email
Relationship To Child
Does your child have any allergies or snack time food restrictions (please list)?
PHOTO RELEASE
I hereby authorize and consent to the use of images or video of my child/children listed on this registration, with or without their name(s), by Lowell First Church of the Nazarene of Lowell, MA for purposes including but not limited to: promotional materials, printed publications, internet posts including social media, television, and other media sources.
I do this with full knowledge and consent and waive all claims for compensation for use or for damages. I release Lowell First Church of the Nazarene, its officers, trustees, employees, and agents from liability for any claims by me or any third party in connection with the use of the image of my child/children listed on this registration.
PARENTAL RELEASE
I, the parent/guardian of this registered child hereby give permission for him/her to participate in Vacation Bible School at Lowell First Church of the Nazarene. I consent to his/her participation in the activities planned for this event and certify that he/she is physically able to engage in the event. I hereby grant to the leader in charge of the group the right to make emergency medical decisions for my child in the event I cannot be reached. I understand I/we release and forever discharge Lowell First Church of the Nazarene, its staff and adult chaperones from any and all claims, demands, actions, or causes of action, past, present or future arising out of any damage or injury while participating in this event. I am at least 18 years of age, I understand the above statement and am competent and to execute this agreement.
Today's Date
