LIALC Concrete & Cranes VBS

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On Sundays, August 1, 8, 15, 22, & 29 at 10:00am-1:00pm. One registration per child please.

Child's First and Last Name *

Child's Date of Birth *

YYYY

Age of Child *

Completed School Year (as of Sept. 2021) [For preschool children, name of accompanying parent.] *

Medical information we need to know, including food allergies *

Home Address, Street, Town, and Zip Code *

Home Phone Number *

Email (address you check regularly) *

Name of Primary Guardian and Cell Phone Number *

Name of Secondary Guardian and Cell Phone Number *

Who may pick up your child at the end of each VBS Sunday at 1:00pm? (Name, relationship if not the guardian, and cell number) *

PARENT SIGNATURE and DATE: My child/children has/have my permission to participate in the LONG ISLAND ABUNDANT LIFE CHURCH events that are being held on SUNDAYS on AUGUST 1, 8, 15, 22, an 29, 2021 at 7-19 EAST MARIE STREET and 24 EAST NICHOLAI STREET in HICKSVILLE NY 11801. I give permission to have my child/children treated in case of medical emergency. In the event of a medical emergency and I cannot be reached, I hereby authorize LONG ISLAND ABUNDANT LIFE CHURCH staff or volunteers, and/or emergency and medical personnel to make emergency medical decisions for my child/children. I understand and hereby agree to assume all of the risks which may be encountered at the activities sponsored by LONG ISLAND ABUNDANT LIFE CHURCH that my child/children will be attending pursuant to this consent and release form. I hereby agree to release, defend, indemnify, and hold harmless LONG ISLAND ABUNDANT LIFE CHURCH and its agents and employees from any and all past, present, and future, known and unknown liabilities, actions, causes of action, claims, expenses, and damages (including without limitation, interest, penalties, court costs, attorney's fees and expenses) resulting from or on account of injury to my child/children, myself or my property or his/her/their property in connection with any event anticipated by this form. I further release any and all claims brought by or through me, including claims for loss of consortium and all similar claims based on relationships with other people. I expressly agree that this release, waiver, and indemnity agreement is intended to be as broad and inclusive as permitted in the State of NEW YORK and that if any portion thereof is held invalid, it is agreed that the remainder shall, notwithstanding, continue in full legal force and effect. I also agree that any controversy or claim, by or through the party signing this release, arising out of or relating to the activities anticipated by this form shall be settled by binding Christian arbitration conducted by the National Center for Life and Liberty or another Christian arbitrator, and judgment on the award may be entered in any court having jurisdiction thereof. This release contains the entire agreement between the parties hereto and the terms of this release are contractual and not a mere recital. I further state that I have carefully read the foregoing release and know the contents thereof and I sign this release as my own free act. This is a legally binding agreement which I have read and understand. *

I will return a signed Covid waiver. My child will wear a facemask. For preschool children, the accompanying guardian will wear a facemask. (I understand that select teachers who are fully vaccinated may remove their facemask to teach.) *

I agree

I disagree

Required

What would help ease your Covid-related concerns? (E.g., vaccInations, more safety protocols, cleanliness...) *

May we have permission to photograph your child for LIALC? *

Yes

Required

Which church does your family attend regularly? *

Which fellowship is your family a part of, who is your fellowship leader? *

Will your child participate in Junior Worship and Sunday school in Sept. 2021? *

How did you hear about us? *

On the first day of VBS on Sunday, August 1st when my child is checked in, I will provide a signed Parental Consent: of Activity; Covid Waiver; Medical Information; I understand the VBS policies are consistent with the LIALC's Statement of Faith; and Photograph permission. LINK <http://www.lialc.org/uploads/5/6/7/7/5677914/lialcconsentfull.pdf> *

I agree

I disagree

Required

Comments *

Thank you for registering your child.

You will receive an email reminder towards the end of July.

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