Registration For VBS July 21st thru 25th, 2008

Redeemer Presbyterian Church (9:00 to Noon each day)
For questions regarding this form, or VBS, please email Candace Blevins
Child's Name:
Birth Date (mm/dd/yyyy):
(Children need to be 4 years old by 7/21/08)
Last grade completed: None/Preschool  K  1st  2nd  3rd  4th
Address Line 1:
Address Line 2:
City:  State:   Zip: 
Parent/Guardian Name:
Phone numbers where you can be reached during VBS:
Home:
Work:
Cell:
In the event of an emergency whom do we call?
First Contact Name:
Phone:
Relationship:
Second Contact Name:
Phone:
Relationship:
Other than yourself, who is authorized to pick up this child at the end of each VBS day?
First Pickup Name:
Relationship:
Second Pickup Name:
Relationship:
Medical or other information we need to know (include food allergies):
Child's T-shirt size: XS/4  S/6-8  M/10-12  L/14-16 
For email confirmation to be sent after we have received and processed your registration, please provide a valid email address. Leave blank if no confirmation is required.
Email Address:
 By checking this, I acknowledge that I am the legal parent or guardian of this child and that I will be required to sign the following waiver when first dropping off my child at VBS:
     "Should emergency medical or dental diagnosis or treatment and hospital care be necessary and I cannot be reached, I authorize the Vacation Bible School or Redeemer Presbyterian Church adult staff to act on my behalf and consent to appropriate diagnosis, treatment, and care pursuant to all applicable law. I hereby release Redeemer Presbyterian Church and the Vacation Bible School staff from any actions, claims, demands or liabilities that may arise as a result of my child's participation in the Vacation Bible School activities."