Stockton Presbyterian Church

2014VacationBibleSchool

REGISTRATION FORM

Participant:______

Age:______Grade Completed:______

Relevant medical conditions, allergies, ______

Address:______

Phone Number (cell or home)______

Email Address:______

(for VBS information only)

Alternate Emergency Contact Information

______

Contact Name Phone Number

WHAT YOU NEED TO KNOW

  1. Our VBS program is a friendly and fun environment where participants can be introduced to Christian religious themes. This year’s theme and curriculum is Weird Animals: Where Jesus’ love is one of a kind.
  1. VBS is a volunteer led program by the members of the Stockton Presbyterian Church and Stockton community.
  1. We gather each day from 9am to noon, June 23-27th.
  1. The cost to participate is $15 per child, or $20 for all children from one family. Checks can be made out to Stockton Presbyterian Church, with VBS in the memo line.
  1. All registration monies go to pay for the program.
  1. Each day, we will collect an offering during our opening time. 100% of this offering goes to Mission Work like Heifer International.
  1. Registration forms can be mailed to the church office, 22 South Main Street, or dropped off at the church office, located upstairs.
  1. Any questions, please contact the church office at 609-462-5737 or email

Stockton Presbyterian Church

22 South Main Street, StocktonNJ08559

609-462-5737

An open fellowship and unique expression of the dynamic living presence of Jesus Christ

Rev. Kenneth Good, pastor Denise Miller, Clerk of Session

ASSUMPTION OF RISK, RELEASE, AND INDEMNITY AGREEMENT

Program / Activity:______2014 Vacation Bible School______

Participant:______

Relevant medical conditions, allergies, etc.______

______

Name of Parent / Legal Guardian (if under 18):______

Address:______

Phone Number (cell or home)______

Email Address:______

Alternate Emergency Contact Name Phone Number:______

______

Parent / Guardian Signature Date

(Terms are on Page two of document)

In consideration of the Stockton Presbyterian Church (the “Church”) allowing my son or daughter (the Participant) to participate in the Activity that is sponsored, hosted by, or otherwise related to the Church, I agree as follows:

1. Authority. I am the parent or legal guardian of the Participant and have authority to enterinto this Agreement. I represent that: a) I have authority to enter into this Agreement on behalf of anyone else who has legal rights regarding the Participant; or b) everyone else with legal rights regarding the Participant has signed this release.

2. Voluntary participation. I agree that my and my Child’s involvement in the Activity is

voluntary.

3. Risk of serious injury or death. I understand that the Activity involves risks that may

resultin serious injury or death to the Participant. I voluntarily assume all such risks.

4. No Duty to Act on Conditions Specific to Participant. I understand and agree that the

Church is not qualified to provide medical evaluation or treatment and that the

number of participants limits the ability of the Church to provide special care or attention to an individual Participant. Therefore, I understand and agree that the Church has no duty to utilize the information above regarding medical conditions or other limitations faced by the Participant.

5. Authorization to Engage Medical Treatment. I grant permission for the Church to

authorize medical treatment for the Participant, to call 911 for emergency medical

aid, or take other measures to secure medical treatment if, in the Church’s sole and absolute judgment, the Participant becomes ill, sustains an injury, or otherwise requires medical treatment. I give consent to any physician, emergency aid responder, or other health care provider to administer drugs or medicine or to perform such medical treatment as such person determines necessary for the relief

of pain or to preserve the Participant’s life or health. I assume full responsibility forall medical, rescue, transportation, and other expenses incurred on behalf of theParticipant and will fully and immediately reimburse the Church for any of theseexpenses that the Church, in its sole and absolute discretion, chooses to advance.

6. Release of Claims. I release and agree to indemnify the Church (and any cosponsors,

hosts, or related organizations), their officers, directors, employees,

agents, and volunteers (collectively, “Released Parties”), from all claims and

liabilities of any kind, known or unknown, including, but not limited to, claims based on the negligence of Released Parties (either individually or collectively), related to or arising, directly or indirectly, from the Participant’s participation in the Activity, including travel to and from the Activity. This release is binding on me and my personal representative and heirs. I have carefully read this document and understand what it says.