VBS Camp Registration

Child Information

Name

First Names of Additional Children (in the same family/with same last name. If you are the parent/guardian of a child with a different last name, please include that as well.):

Age (Please specify the age of each child if registering multiple children)

Allergies (please specify which child if registering multiple children):

Additional Information - Is there anything else you would like us to know?

Parent/Guardian Contact Information

Name

This address will receive a confirmation email

Phone

Address

Agreements & Signature

The undersigned does hereby give permission for my child/children to participate in VBS, sponsored by Windham Presbyterian Church (WPC). We (I) authorize an adult, in whose care the minor has been entrusted, to consent to any X-ray examination, anesthetic, medical, surgical, or dental diagnosis or treatment, and hospital care, to be rendered to the minor under the general or special supervision and on the advice of any physician or dentist licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital. The undersigned shall be liable and agree(s) to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child pursuant to this authorization. Should it be necessary for our (my) child to return home due to medical reasons, disciplinary reasons, or otherwise, the undersigned shall assume all transportation. We (I) understand that there are certain inherent risks involved in activities such as this. We (I) hereby assume all risks and agree to hold harmless WPC and all leaders for any injury or damage, which may result from accident or mishap. (Parental/Guardian Signature in the box below)

I understand that photo and video may be taken of the VBS and consent to WPC using this content on their website and social media:

Yes No

Emergency Contact

Name

Phone

Payment

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

June 24 - 27, 2024, 9:00 am - 12:00 pm

WPC's 2023 Vacation Bible School Day Camp is happening June 24 - 27 from 9:00 am until 12:00 pm each day! We are offering VBS for children entering grades K - 5.

Please contact Anna Hadorn with any questions - anna.hadorn@windhamchurch.org

VBS Camp Registration

Description

Please Fix the Following