VBS Registration 2022

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First United Methodist Church of Homosassa

VBS Dates and times: June 20 - 24, 8:30am - 12pm

PLEASE READ BEFORE FILLING OUT THE REST OF THE FORM

First United Methodist Church of Homosassa wishes to advise all VBS participants and their families about the risk related to COVID-19, which is a contagious disease that spread throughout most countries of the world. Despite declining infection rates and generally safer conditions, The Church does not guarantee or ensure that a person will not become infected. The Church will continue to closely monitor applicable local, state, and federal guidelines, as well as guidelines from the Florida United Methodist Conference.

The Church will strive to limit any risk of infection by complying with the previously mentioned guidelines and recommendations with regards to social distancing, face-coverings, and cleaning and disinfecting. Even with all the steps taken by The Church, we cannot guarantee that you or your child will not be exposed to COVID-19.

Finally, by checking the box below, you acknowledge that you must not bring any child (or any other person) to VBS if that child is suffering any symptoms associated with COVID-19, such as fever, sore throat, shortness of breath, chills, muscle pain, loss of taste or smell, gastrointestinal symptoms (like nausea, vomiting, or diarrhea), and cough. If you or your child are suffering any such symptoms, please notify us immediately and cancel your child's participation in VBS.

Acknowledgement of release/waiver *

I acknowlege that I have read the above release/waiver and I voluntarily agree to abide it's terms.

Required

Child's Age *

Other:

Date of Birth *

YYYY

Grade *

Child's Name *

Parent(s) Name *

Street Address *

City *

State *

ZIP *

Primary Telephone *

Parent/Caregiver's Cell Phone *

Home Email Address

Home Church

Child T-Shirt Size *

Child Size Small

Child Size Medium

Child Size Large

Other:

Allergies or other medical conditions

What are your child's strengths? (Drawing, writing, encouraging, reading, attitude, social relationships, etc)

What are some areas your child struggles with or needs your child has in this environment ( allergies, medical needs, struggles in reading, writing, relating to others, sensory differences, focus and attention...)

Name of Contact #1

Home Phone of Contact #1

Work Phone of Contact #1

Cell Phone of Contact #1

Name of Contact #2

Home Phone of Contact #2

Work Phone of Contact #2

Cell Phone of Contact #2

I GIVE MY PERMISSION for my child to have his/her picture published in the Media to be used for the sole use within the church such as bulletins, the church website, or Facebook page. *

Yes - I give permission

No - I do NOT give permission

In the event of a medical emergency and the church is unable to contact me or the temporary care giver(s), I hereby authorize the First United Methodist Church of Homosassa to have my child (name).... (add the name of your child in the text below)...transported to a clinic or to a hospital for emergency treatment. *

Parents Signature (type your name below) *

Date (today's date)

YYYY

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