Ebenezer Christian Reformed Church VBS Registration and Consent Form
Information received is confidential and is being gathered for the purposes of serving your Child while in the care of Ebenezer CRC.  Any medical information collected here serves to authorize Ebenezer CRC, and its Staff and Volunteers, to obtain medical assistance in emergencies.  This form should be completed by the Parent/Caregiver.
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Welcome to ROAR! VBS 2019!
July 15-19, 2019 from 9:30 a.m. - 12:00 p.m.
Hold onto your hats and join us on safari as we learn that when life is wild, God is good!  Our adventurers will travel together through Wild Bible Adventures, Stampede Sports, Imagination Station Crafts, and Singing (& Roaring!) as we learn about the goodness of a God who loves each and every one of us!  Not to mention snacking at the Hungry Herd Cafe!
Student's First Name: *
Student's Last Name: *
Date of Birth: *
Grade your child is ENTERING as of September 2019 *
Required
Allergies: *
Required
If yes, please explain.
Parent's Name (s): *
Phone Number (Main): *
E-mail:
Mailing Address:
Postal Code:
Emergency Contacts:
Please list two contacts to be reached in case of emergency during this program time:
Primary Contact: *
Phone Number of Primary Contact: *
Secondary Contact: *
Phone Number of Secondary Contact: *
Child's Health Card Number: *
Name of Family Doctor:
Phone Number of Doctor:
Church Affiliation:
How did you hear about us?
Does your Child have any physical, emotional, mental, behavioural concerns or limitations that staff should be aware of? *
Required
If yes, please explain.
Is your Child bringing any medication with them? *
Required
If yes, please list and explain dosage.
Get the music of Roar!  Cost: $12.00 *
The safety of your Child is our primary concern.  Precautions will be taken for their well-being and protection.
I/we, the Parents or guardians named below, authorize Ebenezer CRC Vacation Bible School Ministry Personnel to sign a consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures for the participant named above.

I/we, named below, undertake and agree to indemnify and hold harmless Ebenezer Ministry Personnel, Ebenezer CRC, and its leaders from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of Ebenezer CRC, as well as of any medical treatment authorized by the supervising individuals representing Ebenezer CRC.  This consent and authorization is effective only when participating in events sponsored by Ebenezer Christian Reformed Church.

 
Informed Consent Digital Agreement *
Photos
Please sign below to grant permission for the reasonable use of pictures or video containing your child in one or more of the following ways:
*
Required
Purposes and Extent
Ebenezer Christian Reformed Church is collecting and retaining this personal information for the purpose of enrolling your child in our programs, to assign the student to the appropriate classes, to develop and nurture ongoing relationships with you and your child, and to inform you of program updates and upcoming opportunities at our Church.  This information will be maintained indefinitely as it is a requirement of our insurance company and legal counsel.  If you wish Ebenezer Christian Reformed Church to limit the information collected, or to view your child's information, please contact us.

I have read, understood and agree with above and sign it to cover all Vacation Bible School Ministry activities for the program year effective as stated below.

This form will be printed off, and a parent/guardian signature will be required at registration.
Parent/Guardian Signature: (a parent signature will also be needed at registration) *
Date: *
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Have you HERD about this year's service project?
When life is unfair, when life is scary, when life changes, when life is sad and when life is good . . . God is good!  We're going to be raising funds to help families in the developing world who experience all of these things by raising money to buy a herd— a calf, a goat, and a pig! This herd, along with the World Renew training and support that come with them, is a foundation on which many people who previously subsisted from day to day can build a more abundant life.


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