Eastview Baptist Church 2025 VBS

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Participants Name Participants Name * First Last
Address Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Home/Cell Phone Home/Cell Phone * - ### - ### ####
Emergency Phone Emergency Phone * - ### - ### ####
Email *
Birthdate Birthdate * / MM / DD YYYY
Last Grade Completion in School *
Medical Information (please include food allergies) *
Who may pickup your child each day? Who may pickup your child each day? * First Last
Secondary pickup person Secondary pickup person First Last
DISCLAIMER:

I hereby agree to indemnify and hold harmless and blameless Eastview Baptist Church, Inc. (EVBC), its members, officers, pastors, staff or agents from any and all liability from damages, loss or injuries, either to person or property, which the said minor may sustain while engaged in any activity conducted by or in connection with EVBC including but not limited to transportation. I further certify that I have legal custody by reason of the fact that I am the parent or the legal guardian by court order. I further allege that the said minor is physically able to participate in the activity set forth herein.

I further agree to reimburse or make good any loss or damage or costs that Eastview Baptist Church, Inc. may have to pay if any litigation arises on account of any claim made by said minor, or anyone in said minors’ behalf, resulting directly or indirectly from said minors’ participation in the EVBC activities. I further agree in case of injury or illness or other actions requiring parental permission, the staff of EVBC shall have the authority to act for us, in case we cannot be reached. I further understand that in case of injury, serious illness, or in extreme cases of disciplinary action, the Leader or staff will, if need be, send home my son/daughter by the first available transportation at my own expense. I agree to authorize EVBC to utilize photographed or video graphed images of my child in brochures, flyers, displays or other promotional purposes without any compensation from EVBC.

Any child with special needs is allowed to participate but will need to be accompanied by a legal parent or legal guardian.
I agree to the above disclaimer and terms. *

I agree to the above disclaimer and terms. Agreed
NOTICE

A signed signature is required for participation. Use your computer mouse or finger (touch-screen/mobile device) to sign this document. If you select the option to type the name then you will have to sign a separate permission slip document at the church during onsite registration the day of VBS.
Draw your signature into the box below. *

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Type Name *
Date Date * / MM / DD YYYY

Eastview Baptist Church 2025 VBS

Eastview Baptist Church 2025 VBS

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DISCLAIMER:

NOTICE