Child’s Name *

First Name

Last Name

Birthday *

MM

DD

YYYY

Current Grade *

K4

K5

1st

2nd

3rd

4th

5th

6th

Parent/Guardian Name *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Phone

(###)

###

####

Medical/Injury Release *

I hereby give permission for my child to participate in the Stonington Baptist Church VBS Program. I understand that Stonington Baptist Church is a nonprofit/church which is voluntarily presenting this program for my child, other participants, and the community. I also understand that the program has activities that can involve physical contact with other participants, the ground or equipment, pony rides, bounce houses, etc., and that there is a resulting risk of physical injury to my child. In consideration of my child’s participation in VBS and the use of the Stonington Baptist Church facilities for VBS, I hereby release and covenant not to sue the Church, its members, trustees, directors, officers, employees, representatives, volunteers, agents, and lessees from any and all present claims resulting from ordinary negligence and inherent risk of use of the facilities and equipment of Stonington Baptist Church including, but not limited to, any loss, injury, damage or liability sustained by my child while on or about the premises of Beacon Baptist Church. I also give permission for the staff, representative, or volunteers of Stonington Baptist Church to administer first aid or to seek medical care for my child during my child's participation in the program, including transportation of my child to a medical facility for additional treatment that appears necessary.

I Understand and Agree to the Medical/Injury Release

Photo/Video Release *

I understand that photographs or videos of my child (this registrant) may be used in publications of Stonington Baptist Church (including the church website and social media pages). I understand that these photos/videos may be viewed by anyone but no identifying information will be displayed.

I Understand and Agree to the Photo/Video Release

Allergy Release *

Stonington Baptist Church cannot guarantee that all snacks, foods, candies, etc. are allergen free. Products may contain wheat, egg, dairy, soy, nuts, peanuts, etc. that could cause an allergic reaction to your child. If your child cannot eat the snacks provided due to an allergy or medical condition, please provide your child with a suitable snack.

I Understand and Agree to the Allergy Release