3 in 1 VBS for CTK July 5-7th from 9am

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3 in 1 VBS for CTK July 5-7th from 9am - 1pm

VBS Registration

Child's Name *

Male or Female *

Female

Male

Current Grade level - Write in adult if you are not in school: *

Childs age *

Cell phone Number of Adult Guardian *

Best way to contact you? *

Phone

Mail

Email *

Street Address *

City *

State *

Zip Code *

Child's t-shirt size *

Hold Harmless Agreement & Emergency Contact

CONSENT/LIABILITY & WAIVER
I, grant permission for my child to participate in Religious Education Program to be held at Christ the King Catholic Church in Corpus Christi Texas, on July 5th - 7th from 8am to 2pm. I agree on behalf of myself, my child’s other parent if known or living my child named herein, or our heirs, successors, and assigns, to release and hold harmless and defend the Diocese of Corpus Christi, the sponsoring parish (its pastor, youth minister, principal, other agents, etc.) or any representatives associated with the scheduled activity from all damages, claims, suits, expenses and payments for injury to my child and/or property, including all damages, claims suits, expenses and payments resulting from the negligence of the Diocese of Corpus Christi, and parish, and/or their officers, directors, and employees.
As parent/guardian, I understand that promotional pictures will be taken during this even. I give permission for my son’s/daughters pictures to be used for promotional materials in highlighting the event.

E - Signature - typed is preferred *

Emergency Information Continued

MEDICAL CONSENT
I hereby warrant to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child. In the event of an emergency, I hereby give permission to transport my child to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor. In the event of an emergency and you are unable to reach me.
My child will bring all such medications, well labeled, that are necessary. Names of medications and concise directions for seeing that the child takes such medications, including dosage and frequency are as follows: Medications: I hereby Do grant permission for medication of any type, whether prescription or non prescription to be administered by my child unless the situation is life threatening and emergency treatment is required. I hereby Do grant permission for non prescription medication (such as Tylenol, throat lozenges, cough syrup) to be given to my child, if deemed advisable. I understand that Aspirin will not be given to my son/daughter. Please inform us if your your child has: __Seizures __Asthma __Diabetic __had surgery in the past 6 months __ has a medical prescribed diet

E-Signature - typed is preferred *

What to Bring

• Change of Clothes.
• Towel & messy clothes for water games.
• A bag to put crafts in.
• Sunscreen & Water Bottle

Submit

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