Vacation Bible School

Child’s Information:

First Name

Last Name

Gender

Age

T-shirt size

Family Information:

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email

Phone

(###)

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Emergency Contact:

First Name

Last Name

Phone (Emergency Contact)

(###)

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I understand that reasonable precautions will be taken to safeguard the health and well being of the participants in this VBS and that I will be notified as soon as possible in the event of an emergency. In the case of sickness or an accident, I authorize and consent the VBS Team, or other associated volunteers of the VBS program to obtain medical care from a licensed physician, hospital, or medical clinic for my son/daughter in the event that myself or other legal guardian(s) cannot be reached. I hereby do release and forever discharge Cat.Chat Productions Inc., this Diocese, and this Parish, from all manners of actions, claims, which I or the child named above shall or may have for any reason, arising during my child’s attendance of the VBS. Unless other written instruction is submitted, I also consent to allowing my child’s image to be recorded, either by photograph or video, and used during the VBS week or for future advertisement of Cat.Chat VBS programs.