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VBS Registration Form

 Monday, July 21 & Tuesday, July 22    7:00-8:45 p.m. 

for kids entering K-5th Grade

 Child's Name

 Name Child Prefers to be called

 Gender        School Grade Child is entering for 2008-2009 year

 Mother's Name      Father's Name

 Home Phone         Cell Phone

 Address      City     State       Zip

 Email address

 Emergency Contact Name Phone Number

 I have read and agree to the Medical Release Form below:

In accordance with medical obligation, I, the parent/guardian of above named child, do hereby verify that the above mentioned information is correct and I do hereby release and forever discharge the staff, leadership, and the body of Eastridge Community Church of Covington, Georgia from any and all claims, demands, actions or cause of action past, present or future arising out of damage or injury while participating in events and activities with Eastridge Community Church of Covington, Georgia.

I am the parent or legal guardian of the above mentioned participant, and do hereby grant permission for the said participant to be fully involved in activities sponsored by the Children’s Ministry of Eastridge Community Church of Covington, Georgia.  Permission is granted to take the participant to a doctor or hospital and I do hereby authorize medical treatment, including, but not limited to, emergency surgery or medical treatment and assume the responsibility of all medical expenses.

If need arise for the participant to return home due to medical reason, disciplinary action or otherwise, I will assume all transportation arrangements.

 Medical Conditions

 Current Medications

 Allergies

 List any Special Needs

 Child's Home Church

 Name one special friend your child might like to be paired with.

For Visiting Guests Only
 I am a special guest of one Eastridge member

Please fill this section only if you are

Volunteering at VBS on Monday & Tuesday

I will need childcare for a younger child (Babies-PreK) Yes                No

Please list the name(s) and ages(s) of children you need for childcare for:

Volunteer Name:

e-mail  Phone #

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For Kidstuf family services on Sunday and Wednesday July 20th and 23rd.

Please fill out ONE per family.

Sunday, July 20   # of Adults:                      Wednesday, July 23  # of Adults: 

               # of K-5th Graders:                                            # of K-5th Graders:          

                 # of Preschoolers:                                              # of Preschoolers:   

 

**We take photos during VBS which we may place on our church website.

If you do not want your child’s photo on this site, please notify our Children’s Ministry Department in writing.