Hamilton Christian Center / Vbs / Vbs

Gadgets & Gizmos Vacation Bible School

June 21-23, 2017

W-F: 7pm-9pm

Register your child/ren for Gadgets & Gizmos 2017 by filling out the information below:

Child 1: (First & Last Name)

Child 1 Age:

Child 2: (First & Last Name)

Child 2 Age:

Child 3 (First & Last Name)

Child 3 Age:

Child 4 (First & Last Name)

Child 4 Age:

Your contact info:

Parent/Legal Guardian (First & Last Name):

Please enter your full address:

Street Address

City

State

Zip Code

Phone Number

Email Address

What is the best way to reach you?

Email

Phone

Emergency Contact

Pleas provide an emergency contact that you trust to care for your child/ren in case of an accident and we are unable to reach you:

First & Last Name:

Phone #:

Relation To Child:

Dismissial Information

Who may pick up your child at the end of each VBS day?

Other Information

Does your child/ren attend HCC's Kidz Klub & Sunday School?

If your family is visiting our church, who are you a guest of?

May we have permission to photograph your child/ren?

May we use your child's photograph for the purpose of promotional material?

Health & Medication Information

PARENTS: Please complete this form with details relating to your child/ren's health and medication. The information you provide will enable us to be aware of any special needs or medical conditions that affect your child/ren.

Allergies? If yes, please list and explain the reaction that is possible:

Treatment required for allergic reaction:

Will your child have necessary treatment with them during VBS?

Is your child responsible for maintaining medication and to administer as needed? If YES, label all medication with child's name and dosage information. Each prescribed medication must be in the original container with a pharmacist's label.

List any serious illness, injury, or syndrome

Emergency Medical Authorization Liability Release Form:

Part 1:

In consideration for being accepted by Hamilton Christian Center for participation in Gadgets & Gizmos VBS, I do hereby release, forever discharge and agree to hold harmless Hamilton Christian Center and the directors thereof from any and all liability, claims or demands for personal injury, sickness, or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the participant that occur while said person is participating in the above-described activity including recreation and work activities. The undersigned further hereby agrees to hold harmless and indemnify said school, its directors, employees and agents for any liability sustained by said acts of said participant, including expenses incurred attendant thereto.

Part 2:

The undersigned further consents to the administration of first-aid and/or doctor's care, or any other form of medical treatment necessitated by illness or injury that may require the same. In the event of the necessity of such care or treatment as heretofore described, the undersigned agrees to hold harmless and indemnify said school, its directors, employees, and agents fromany acts of malfeasance, and/or failure to act on the part of those chosen to administer medical care on behalf of the participant.

If you agree to the release of these claims, please type your full name and date:

Additional Information And/Or Questions:

Event Registration