VBS Registration Form
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Parent/guardian first and last name *
Parent/guardian cell phone *
Parent/guardian email *
Street address, city, zip code *
Child first name *
Child last name *
Gender *
Date of Birth *
MM
/
DD
/
YYYY
Last grade completed as of June 2023 *
Allergies/medical needs *
By clicking "yes" below, I agree to the following releases:

Medical Release: I (we), the parent(s) or guardian(s) of the above listed child(ren), grant permission for our chlild(ren) to participate in Vacation Bible School/Week of Fun at Northmont Church and to receive medical treatment if necessary. If I (we) or the listed child care provider or emergency contact person cannot be reached, I (we) give permission to the staff to secure the services of a licensed physician to provide necessary care, including anesthesia, for my child(ren)'s well-being. I (we) also release and agree to hold harmless Northmont Church and all its participants from any liability, and assume all risk of injury, damage, or expenses as the result of participation in activities in Vacation Bible School.

Photo/Video Release: I (we) understand that as a participant in Northmont Church's VBS, my child(ren) may be photographed/videotaped during VBS events. I (we) also understand that these photographs/videos may be used in presentation and promotional materials, and published in the church newsletters, NUPC social media in accordance with the photo policy at NUPC. I (we) release Northmont Church from any and all liability.

Do you agree to the above?
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