VBS 2024 July 14th

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VBS 2024 July 14th - 18th

Welcome!!
Join us for a FREE fun-filled week at BREAKER ROCK BEACH!
This is for children from Ages 3 to Finishing 5th Grade.
Dinner starts at 5:15 pm.
VBS runs from 6:00 to 8:00 pm.

Osco Community Church, 311 Main Street, Osco, IL
If you have any questions, please call the church office at (309) 522-5561
or email at office@oscochurch.org

Participant First Name *

Participant Last Name *

Does this participant have any known allergies, chronic illnesses, or other conditions the leadership should be aware of? (If not please type "None"). *

Date of Birth *

YYYY

Grade Completed in May 2024 *

None (Child must be at least 3-years-old)

Pre-K

Kindergarten

1st Grade

2nd Grade

3rd Grade

4th Grade

5th Grade

Parent/Emergency Contact Information

If you are registering two or more people, you only need to fill out this section once.

Parent/Guardian (First & Last Name) *

Address *

City /State *

Zip Code *

Cell phone number *

Please provide a Cell phone number that you can receive text messages for EMERGENCY PURPOSES only. We will only use the text message service to notify you of weather cancellations and emergencies.

Email Address *

We will only use this email for VBS related information in an effort to keep you informed.

Home Church

Please list anyone else that you authorize to pick up your children.

Emergency Contact Name *

Please provide an emergency contact other than a parent in the event that a parent cannot be reached.

Relation to participant *

Emergency Contact Phone Number(s) *

Medical Release: *

I/We have legal custody of the student(s), a minor, and have given our consent for him/her to attend events being organized by Osco Community Church. I/We understand that there are inherent risks involved in any ministry or athletic event, and I/We hereby release the Church, its pastors, employees, agents, and volunteer workers from any and all liability for any injury, loss, or damage to person or property that may occur during the course of my/our child’s involvement. In the event that he/she is injured and requires the attention of a doctor, I/We agree to hold such person free and harmless of any claims, demands, or suits for damages arising from the giving of such consent. I/We also acknowledge that we will be ultimately responsible for the cost of any medical care should the cost of that medical care not be reimbursed by the health insurance provider. Further, I/We affirm that the health information provided below is accurate at this date and will, to the best of my/our knowledge, still be in force for the student named above. I/We also agree to bring my/our child home at my/our own expense should they become ill or if deemed necessary by the student ministries staff member. (Please reply YES or NO)

Medical Insurance Company

Policy Number

Photo Release: *

I/We hereby agree to give Osco Community Church in Osco, Illinois, all rights to use my child’s photograph, name, or fictional name for any lawful purpose, publicity, advertisement and duplication without further consent.

Yes

Volunteering: *

We ask that all volunteers fill out a confidential Volunteer Application form before being permitted to work with youth and children. The application shall consist of a criminal background and reference check.

I/We would be willing to volunteer.

Yes

Do you need to add other participants? *

Yes

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