FAITH LAB - REFUGE 2019 VBS JULY 22-26TH

VBS REGISTRATION FORM:
Parent(s) Name: *
Contact Information: *
Email Address: *
Address: *
Emergency Contact Information: *
Child's Name/Grade in the Fall/T-shirt Size Please indicate Youth or Adult size. *
Child's Name/Grade in the Fall/T-shirt Size Please indicate Youth or Adult size.
Child's Name/Grade in the Fall/T-shirt Size Please indicate Youth or Adult size.
Child's Name/Grade in the Fall/T-shirt Size Please indicate Youth or Adult size.
Authorization to consent to treatment of Minor/Release from liability: I, the undersigned parent of above minor(s) do hereby give the directors, counselors and/or pastor of Refuge Church the authorization to give or seek whatever emergency medical treatment they may deem necessary in the event of injury to my child if they are unable to reach me for my consent in a reasonable period of time. I have read the above and consent to our child participating in VBS activities. WE HEREBY RELEASE Refuge Church of Lynnwood, WA it's officers, directors and /or agents from any and all liability. Please sign below, date and return *
ALLERGIES: Please indicate child and corresponding allergy.
Should be Empty:

Science Inspired, Christ Focused VBS Program