VBS Student Registration 2017
July 10 - 14,  8:30am - 12pm

Cost: $10 per child, $30 family maximum. Payment accepted on first day of VBS

 

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Student Name *
Student Name
nickname if applicable
Gender *
Birthdate
Birthdate
PARENT NAME *
PARENT NAME
Address *
Address
Home Phone *
Home Phone
Mobile Phone *
Mobile Phone
Name & phone number
PHOTO RELEASE: *
Section
I / we, the parent(s) of the above listed child, do hereby grant to the Children's Ministries Program Director, the right and authority to make medical decisions and to obtain medical treatment for the child listed below in the event that an emergency medical situation arises while my child is on the premises of Twin Oaks Presbyterian Church. The undersigned agrees to hold harmless and by signing below fully releases Iva Voga and Twin Oaks Presbyterian Church Corporation, any of their affiliates and any affiliated persons chargeable with any supervisory or any other responsibilities or liability, relating to emergency medical treatment. I / we, the parent(s), agree to be responsible for any emergency medical expenses involved in helping our/my child. *
I / we, the parent(s) of the above listed child, do hereby grant to the Children's Ministries Program Director, the right and authority to make medical decisions and to obtain medical treatment for the child listed below in the event that an emergency medical situation arises while my child is on the premises of Twin Oaks Presbyterian Church. The undersigned agrees to hold harmless and by signing below fully releases Iva Voga and Twin Oaks Presbyterian Church Corporation, any of their affiliates and any affiliated persons chargeable with any supervisory or any other responsibilities or liability, relating to emergency medical treatment. I / we, the parent(s), agree to be responsible for any emergency medical expenses involved in helping our/my child.
This is your digital signature.
Insurance Company Phone Number *
Insurance Company Phone Number