VBS REGISTRATION FORM - AUG. 19 - 23, 2019

Name

First Name

Last Name

Email adress

Birthdate

Family Physician:

Parents/Guardians Names

Mailing Address

Home Church:

Health Card Number (This will speed up process if child needs to be take to hospital in rare case of an emergency .)

Any Physical, Emotional, Behavioural Concerns:

Yes

If you checked yes, please give brief details of concern.

Allergies:

Does your child require an Epi-pen?

Yes

Is your child bringing an Inhaler?

Yes

Emergency Contact: Phone No.:

Who may pick your child up at end of VBS?

PHOTO CONSENT

I/We grant permission for the reasonable use of pictures containing your child in brochures, promotional material, church newsletters, website, newspaper, etc.

yes

CONSENT: PLEASE SUBMIT YOUR EMAIL ADDRESS TO CONFIRM YOUR CONSENT FOR THE FOLLOWING: I/we the parents or guardians named on this registration form, authorize one of the Bancroft Pentecostal Tabernacle approved Ministry Volunteers to sign a consent for medical treatment and to authorize any physician or hospital to provide medical assessment, treatment or procedures for the participant named on this registration form. I/We, named on this registration form, undertake and agree to indemnify and hold blameless, Bancroft Pentecostal Tabernacle, its pastors, representatives and Board of Elders from and against any loss, damage or injury suffered by the participant as a result of being part of the activities of the Bancroft Pentecostal Tabernacle. This consent and authorization is effective only when participating in or traveling to events of the Bancroft Pentecostal Tabernacle.

MINISTRY TIMES

OFFICE HOURS