subject_line
1. Child's Name
*
Age:
*
5
6
7
8
9
10
11
12
DOB:
*
+
Medical Notes/Allergies or Special Instructions:
*
2. Child's Name
Age:
5
6
7
8
9
10
11
12
DOB:
+
Medical Notes/Allergies or Special Instructions:
3. Child's Name
Age:
5
6
7
8
9
10
11
12
DOB:
+
Medical Notes/Allergies or Special Instructions:
4. Child's Name
Age:
5
6
7
8
9
10
11
12
DOB:
+
Medical Notes/Allergies or Special Instructions:
Name of Parent/Guardian:
*
Phone Number:
*
Name of Additional Emergency Contact Person:
*
Relation to Child and Phone Number
*
In case of emergency and I cannot be reached by phone, I give Fredericksburg Church staff and/or volunteers permission to seek medical treatment for my child or children. I release Fredericksburg Church from any and all liability for any injuries which might occur during activities of this Vacation Bible School Day Camp.
*
I do
Fredericksburg Church may take photos or videos of children participating in today’s activities. These photographs or videos may be used in slideshows, emails, bulletin boards, church brochures, church website or social media to publicly promote Fredericksburg Church. Anytime pictures of children appear on the internet there will not be any personal identification (i.e., student name). I consent that such pictures or videos shall be the property of Fredericksburg Church and may be used as the church or its leadership deem appropriate. I will not be compensated, nor will I seek compensation for the photos or videos.
*
I give my consent to use my child's (children's photo/video as described above.
I DO NOT give my consent to photo/video use as described above.