2023 Stellar Vacation Bible School Registration

Emergency Contact Name (First & Last): *

Child's Name (First & Last): *

Allergies or Medical Info We Should Know *

By registering my child for this event I give my consent for my child to participate in all activities associated with Trinity UCC’s VBS. In good faith, I agree not to hold Trinity UCC or any representatives responsible for any injuries, incidences or medical expenses associated with their participation in this event. I (we) understand that staff, volunteers, and leaders will make every attempt to contact me as soon as possible if an emergency arises. If I (we) cannot be reached I give Trinity UCC’s staff, volunteers, and leaders authorization to take me child to a doctor or hospital at my own expense. I understand that my child may be videotaped or photographed as part of this event and this media may be used in promotional materials for Trinity UCC in print/web. *

Address *

Email: *

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City, State, Zip Code *

Emergency Contact Relationship to Child *

Child's Age *

Parent(s) Name(s) (First & Last) *

Is Trinity Your Home Church? *

Last School Grade Child Completed *