VBS 2015
firstChristian Church
New for 2015
Ages 4—5 years
July 20—23rd
9:30am—Noon
Ages 6—10 years
July 19—22nd
6:30—8:45pm
Family FX Night
July 23rd
6:30—8:45pm
Child 1 Name:
Gender: M / F
Date of Birth:

4—5 years (July 20—23rd 9:30am—Noon)

Child 2 Name:
Gender: M / F
Date of Birth:

4—5 years (July 20—23rd 9:30am—Noon)

Child 3 Name:
Gender: M / F
6—10 years (July 19—22nd 6:30—8:45pm)
6—10 years (July 19—22nd 6:30—8:45pm)
Date of Birth:

4—5 years (July 20—23rd 9:30am—Noon)
Address:

6—10 years (July 19—22nd 6:30—8:45pm)
City/State/Zip:
Parent(s)/Guardian(s):
Phone 1:
Parent’s E-Mail:
Phone 2:
Emergency Contact:
EC Phone:
(Emergency Contact other than parents or guardians listed)
Please list any allergies or medical needs:
My child agrees to conduct him/herself in a manner that would represent Christ in a positive way. In the event my child
does not adhere to the behavior policies designated by the Church, he/she will be asked to leave and it will be up to the
parent to pick up the child from the event.
I give permission for my child to attend VBS at firstChristian Church. I acknowledge that participation in VBS activities may
involve certain risks and hazards of injury and/or property damage. I understand all reasonable safety precautions will be
taken by firstChristian Church. I do not hold firstChristian Church, board members, supervisors, teachers, employers and
volunteers liable for any accident, injury or disease incurred by my child. I release and waive any liabilities against
firstChristian Church, it's employees and volunteers. I authorize the administration of medical treatment to my child if
needed. I assume responsibility for costs that arise from medical treatment that are not covered by my insurance. I understand that in the event medical intervention is needed every attempt will be made to contact the parent or guardian immediately.
From time-to-time, for promotional purposes, videos and photographs are taken at church sponsored camps and events.
Your attendance constitutes permission for firstChristian to use your, or your family member’s, likeness in promotional
materials. By attending a church sponsored event, you are agreeing to this photography/video release.
Parent’s Signature
Date
Return Registration by July 16 — OR— Register Online http://firstchristiannorfolk.org/childrens-ministry/