MEDICAL INFORMATION AND LIABILITY RELEASE FORM
Vale United Methodist Church
Vacation Bible School, July14 – 18, 2014
Emergency Contact Information
In the event of an emergency or other significant concern, the youth’s parents or guardians will be contacted. Please provide the name, relationship to the child, and phone numbers.
Parent or Guardian: ______Relationship: ______
Phone Numbers: W: ______Cell:______
Parent or Guardian: ______Relationship: ______
Phone Numbers: W: ______Cell:______
Medical Information
Personal medical insurance is required.
Medical Insurance Company: ______
Policy #: ______
Consent for Medical Treatment/Liability Release
As the parent or guardian of the child enrolled participating in Vale United Methodist Church program, I understand that these programs, activities, games and elements can be hazardous by nature and I assume all risks of injuries arising from participation. I realize, indemnify and hold harmless Vale United Methodist Church and its directors, volunteers and staff from any claim, suit, demand or action arising in connection with the child’s participation.
Personal medical insurance is required. If the child requires medical attention every effort will be made to contact the child’s parents, guardians or emergency contacts. In the case of an emergency, the child will be provided emergency medical services prior to informing the parent or guardian. I assume responsibility for any cost incurred in treating the child. I waive any liability or accountability to Vale United Methodist Church for the quality or cost of medical services provided.
The child’s parent or guardian is responsible for any property damage caused by the child. If a child’s property is lost or stolen, we will make every effort to locate it. However, Vale United Methodist Church accepts no responsibility for the loss or damage to a child’s property.
Please sign below:
Signature of Parent or Guardian: ______Date ______
Print Name ______Relationship ______
July 14-18,
9:30- Noon
Where Faith Grows and
Hungry People are Fed
Cost - $30.00 per child; $50.00 per family
after June 30th - $35.00 per child; $70.00 per family
(One form per family)
Child(s)Name, Age & Grade______
______
______
______
Allergies/medical information or other concerns:______
______
Parent/Guardian’s Name: ______
Address ______
Telephone #’shome______
work______cell ______
Email address ______
HomeChurch ______
List name of persons who may pick up this child from VBS each day.______
______
______
(Church use only) Assigned Tribe:
VOLUNTEER OPPORTUNITIES
JULY 14-18,2014
Vacation Bible School is a community outreach program that relies heavily on the generous contributions of time and talent from many church members. Whether you have children enrolled or not, there are many ways to help. Please take a moment to consider the needs below, and how you might be able to give a portion of your time. We especially need people who are available for the entire week of VBS, but even an hour of your time,before or during VBS, can make a difference. Do not miss this opportunity to participate in the joyful event!
Please check all that apply
BEFORE, I would like to help by:
Providing snack supplies
Preparing craft materials
Decorating the church
Set-up
Purchasing materials
DURING, I would like to help as a:
Registration assistant
Nursery worker
Preschool Aide
Recreation helper
Shop Keeper
Snack helper
Music helper
Photographer
Small group shepherd
Wherever you need me (how many days?) ______
AFTER, I would like to:
Help clean up on Friday afternoon
Name: ______
Phone #’s ______
Email ______
If you have any questions about “Abundance Orchard”or your participation in the program, please contact Ruth Anne Luckenbaugh, 703-400-1577.
Experience this fun, event at Vale UMC
as we experience the stories
of God’s people being fed
Abraham and Sarah entertaining angels
Jacob and Esau’s birthright for stew
The Passover
Manna and quail in the desert
Elijah and the Widow of Zarephath