Please complete one form for each child who will attend -- thank you so much!

Please complete all questions below and mark initial boxes -- thank you!

All transportation for students is the responsibility of parent/guardians.  Vacation Bible School cannot transport students either from or to home. You may list those who are authorized to pick up your child, as well as those who may not, under any circumstances, pick up your child from Vacation Bible School. If a person who may not pick up your child is a biological parent, we must have a court order signed by a judge to support your request.   Please list each person's name, contact info and relationship to student.

 I, for myself, my minor child(ren) and for the child(ren)’s other parent(s) and/or guardian(s), hereby release, waive, discharge, forever hold harmless and covenant NOT to sue Bound Together, All Saints Episcopal Church - Pontiac, St. James Episcopal Church - Birmingham, Church of the Resurrection - Waterford, St. Davids - Southfield or any individual or several sponsoring organizations , and each of their officers, directors, employees, agents, volunteers, heirs and assigns of and from all liability, loss, claims, demands, causes of action, court costs, attorneys' fees and other expenses arising from or relating to any loss, damage or injury to my child(ren)’s person or property in any way resulting from or connected with my child(ren)’s attendance at ON THE SEA:  Water Camp VBS even if the claims arise from loss or injuries caused by the sole negligence or fault of those hereby released (including, without limitation, the failure of anyone to enforce rules and regulations or to make inspections).

We want to inform you and request permission to use your child's photograph/image or a film, video or sound recording of your child on  website and in  promotional materials or other displays, including but not limited to bulletin boards, wall photographs, posters, brochures, newspapers, magazines, reports or other public documents; or in film, electronic or digital recordings.

Personally identifiable information related to your child will not be released at any time, for any reason in any public forum.  

As the parent/guardian:  Vacation Bible School requests the use, as described in this document and without identifying information, any photograph, image, film, video or sound recording (otherwise known as “image or recording”)that includes my child. I understand that any image or recording of my child may be used without further consent or authorization from me; that Bound Together may modify the image or recording in the process of editing; and that neither I nor my child am entitled to compensation for use of any image or recording. I also agree to release all sponsoring organizations' board of directors, employees, volunteers and agents from any and all liability arising out of or connected to the use of the image or recording, as stated above. If I, as the parent or guardian, wish to rescind this agreement, I may do so at any time in writing.

In the event my child(ren) become(s) ill or injured, I give my permission for a representative of any of the sponsoring organizations to take whatever steps are reasonably necessary to render emergency first aid to my child(ren). I also consent to such emergency medical treatment as may be reasonably necessary to insure the health and welfare of my child(ren) including, but not limited to, x-rays, anesthetic, medical or surgical diagnosis and treatment, hospital care and administration of drugs or medicine under the care of a licensed physician and/or surgeon.

By completing and submitting this form I certify that all information detailed in this document, Parental/Guardian Contact Info, Emergency Contacts, Release of Liability, Image/Recording Consent, Consent to Treat and Pick-up Release List are accurate and truthful.