VBS 2023! July 17-21
Kids Sign-Up - Please complete form once for EACH child!

6:15 - 8:15 PM
Closing family program Friday 6:30 PM
Grace Reformed Baptist Church, Mebane NC
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Child Name (First AND Last) *
Parent/Guardian Name (First AND Last) *
Emergency Contact (name, relation and phone number) *
Email Contact *
Grade (rising into in fall 2023)  *
Allergies *
Required
Does your child need to be picked up and dropped off by a member of the VBS team? (Available to community members at select neighborhoods near GRBC.) *
If you answered NO to the previous question, please list any adults (aside from yourself) who you authorize to pick up your child. If none, type “None”. Please be mindful that pick up is at 8:15- VBS volunteers should designate at least one other adult. *
Promotional Release:

I hereby consent to the use of any videotapes, photographs, slides, or any other visual or audio reproduction in which my child may appear to Grace Reformed Baptist Church. I understand that these materials may be used in a VBS slideshow or for promotion of the ministry of this church. I release Grace Reformed Baptist Church from any liability connected with the use of the picture or voice recording as part of any promotional program.
 *

VBS 2022 Waiver Form

 As the parent or legal guardian of youth named above, I hereby give permission for my child to participate in the Grace Reformed Baptist Church VBS Program. I understand that Grace Reformed Baptist Church is a nonprofit charitable institution, which is voluntarily presenting this program for my child, other participants, and the community. I also understand that the program has activities that can involve physical contact with other participants, the ground or equipment, and that there is a resulting risk of physical injury to my child. I also understand the program offers rides to participating children and that I hereby grant adult members of this program to drive my child(ren) to and from this program.

I have explained these risks and benefits of participating in this program to my child and my child is in proper physical condition and has no existing injuries or conditions that could jeopardize his/her safety or health, or the safety or health of the other participants.

I therefore release and discharge all liability for any harm or injury suffered directly or indirectly as a result of my child's participation in the Grace Reformed Baptist VBS Program, whether or not resulting from negligence, and I agree not to sue Grace Reformed Baptist Church, its representatives, staff, or volunteers on any such claim. I also give permission for the staff, representative, or volunteers of Grace Reformed Baptist Church to administer first aid or to seek medical care for my child during my child's participation in the program, including transportation of my child to a medical facility for additional treatment that appears necessary.


Digital signature of parent/guardian.*


I have agreed to submit this application by electronic means. By signing this consent electronically, I certify under penalty of perjury and false swearing that my answers are correct and complete to the best of my knowledge.

(type name and date below to sign)

 *
Thank you for signing up for VBS! 
If you have any questions or wish to know more please reach out to office@grbc.net .

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