VBS Registration Form

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Name*

First Last

Age*

Date Of Birth*

Allergies

Additional Children

Age

Date of Birth

Allergies of Additional Children

Parents Name*

Phone*

Country Phone Number

Email*

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Emergency Contact*

Relation to Student*

Phone*

Country Phone Number

Medical Concerns*

Name of Family Doctor*

Dr. Phone Number*

Country Phone Number

Home Church

NOTE:

The following individuals are authorized to pick up my child from VBS meetings. All individuals must be at least 18 years of age and be prepared to show a picture I.D. if he/she is not recognized by a staff member.

Name

First Last

Phone

Country Phone Number

Relation to Student

Name

First Last

Phone

Country Phone Number

Relation to Student

Please Read:

I hereby give permission for my child/children, named on this form, to attend and participate in activities sponsored by Desert Cove SDA Church from July 14th, 2025 to July 18th, 2025. I authorize an adult, in whose care the minor has been entrusted to consent to emergency medical treatment to be rendered to the minor under the general or special supervision and advice of any physician or dentist licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital. I understand, however, that every effort will be made to contact me before any such medical treatment is administered. I understand that I am liable and agree to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child pursuant to this authorization. I hereby release Desert Cove SDA Church from any responsibility other than normal supervision and care. In case of an accident, I will not hold Desert Cove SDA Church, or it staff members, management or officers liable unless guilty of negligence. ************************************* I hereby consent to my child being interviewed, photographed or video taped by representatives of Desert Cove SDA Church for use in advertising, publicity or educational activities including, but not limited to, church participation and /or videos, print and television broadcasts, news and church websites. I hereby wave any claims I may have and release the church and its employees from any liability or claims arising our of such activities.