2021 Central Baptist Church VBS
Sign up for Vacation Bible School at Central Baptist Church.
Dates: August 6-8, 2021
Schedule: Friday: 6:00 p.m - 8:30 p.m.
Saturday: 6:00 - 8:30 p.m.
Sunday Morning: 9:30 a.m. - noon
Sunday Evening: 6:00 p.m. - 8:30 p.m.
Dinner served every night and breakfast on Sunday Morning.
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Child's Name *
Child's Age *
Child's Birth Date *
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MM
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AAAA
Last grade completed in school *
Medical Information
(Please include any food allergies.)
Parent/Guardian Name
Address
(street address, city, state, and zip code)
Phone Number
(including area code)
Email
Emergency Contacts
(other than listed above) (include contact information)
Dismissal Information *
Who may pick up your child at the end of each VBS day?
Does your child attend church? If so, where?
If your child is visiting our church, who is he/she a guest of?
Participation Agreement
I acknowledge that participation in the activity described above involves risk to the participant (and to the participant’s parents or guardians, if the participant is a minor), and may result in various types of injury including, but not limited to, the following: sickness, exposure to infectious/communicable disease, bodily injury, death, emotional injury, personal injury, property damage, and financial damage.

In consideration for the opportunity to participate in the activity described above (the “activity”), the participant (or parent/guardian if the participant is a minor) acknowledges and accepts the risks of injury associated with participation in and transportation to and from the activity. The participant (or parent/guardian) accepts personal financial responsibility for any injury or other loss sustained during the activity or during transportation to and from the activity, as well as for any medical treatment rendered to the participant that is authorized by the sponsor or its agents, employees, volunteers, or any other representatives (collectively referred to as the “activity sponsor”). Further, the participant (or parent/guardian) releases and promises to indemnify, defend, and hold harmless the activity sponsor for any injury arising directly or indirectly out of the described activity or transportation to and from the activity, whether such injury arises out of the negligence of the activity sponsor, the participant, or otherwise.

If a dispute over this agreement or any claim for damages arises, the participant (or parent/guardian) agrees to resolve the matter through a mutually acceptable alternative dispute resolution process. If the participant (or parent/guardian) and the activity sponsor cannot agree upon such a process, the dispute will be submitted to a three-member arbitration panel for resolution in accordance with the rules of the American Arbitration Association.
COVID Waiver
Coronaviruses, like COVID-19, SARS, and the common cold, are a large family of viruses that can cause mild to severe upper or lower respiratory infections. Coronaviruses are contagious and believed to be spread by person-to-person contact.

Central Baptist Church cannot guarantee that I (or my minor child) will not be exposed to, become infected with, or suffer injury from a coronavirus or other communicable/infectious disease or sickness while on the premises, while traveling to any organizational activity, or while engaged in any organization-related activity.

By signing this agreement, I acknowledge the contagious nature of coronaviruses and other communicable/infectious diseases and sicknesses. I voluntarily assume the risk that I (or my minor child) may be exposed to, infected by, or suffer injury from a coronavirus or other communicable/infectious disease or sickness while at the organization, while being transported in connection with the organization, or while participating in organization-related activity. I further acknowledge that such exposure or infection may result in bodily injury, personal injury, emotional injury, illness, permanent disability and/or death, as well as medical expenses and other costs for myself (or my minor child).

I understand that the risk of becoming exposed to, infected by, or injured from a coronavirus or other communicable/ infectious diseases or sicknesses at Central Central Church may result from the acts, errors, omissions, or negligence of myself and others, including, but not limited to, Central Baptist Church leaders, employees, volunteers, and other participants. I voluntarily agree to assume all the foregoing risks and accept sole responsibility for any injury, illness, or death to myself (or my minor child).

On behalf of myself (or my minor child), I hereby release and promise to indemnify, defend, and hold harmless Central Baptist Church, its employees, leaders, owners, agents, and representatives, of and from any claim of any kind. A claim includes all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating to the exposure to, contraction of, or injury from a coronavirus or other communicable/infectious disease or sickness.
Photo/Video Policy
By attending Vacation Bible School at Central Baptist Church, I understand that my child may be photographed and used in promotion of Central Baptist activities. If there is a reason that your child cannot be photographed, please let a VBS leader know.
Parent/Guardian Signature (type Full Legal Name) *
By typing your name, it is your digitial signature and you affirm your agreement with the Participation Agreement and COVID Waiver.
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