Register for VBS

Family Information

Address

Primary Phone

Alternate Phone

Relationship to Student Father Mother Grandfather Grandmother Great-grandfather Great-grandmother Brother Sister Uncle Aunt Guardian Foster Parent Granduncle Grandaunt Other

Phone Number

Student Information

Gender

Birth Date

Age Group

Food Allergies

Details

Medical Concerns

Details

Does your child need transportation via the church bus? Yes No

I have read and agree to the Liability Release Agreement Yes No I understand that my child’s participation in activities at Revival Hope Tabernacle and JAM Kids, including Vacation Bible School and special events (such as water activities and inflatables), is voluntary. I hereby release and hold harmless Revival Hope Tabernacle, JAM Kids, their staff, volunteers, and leadership from any and all liability for accidents, injuries, or damages that may occur during participation, except in cases of gross negligence. I acknowledge that I assume all risks associated with my child’s participation.

I understand that Revival Hope Tabernacle and JAM Kids are not responsible for lost, stolen, or damaged personal belongings. Yes No

I give permission for my child to be photographed and/or recorded and for these images to be used by Revival Hope Tabernacle and JAM Kids. Yes No I give permission for my child to be photographed and/or recorded during activities at Revival Hope Tabernacle and JAM Kids, including Vacation Bible School and special events. I understand that these photos and videos may be used for church purposes, including but not limited to social media, website, promotional materials, slideshows, and other church publications. I understand that no compensation will be given and that these images will be used in a positive and appropriate manner.

Shirt Size Youth X-Small Youth Small Youth Medium Youth Large Youth X-Large Adult Small Adult Medium Adult Large Adult X-Large Adult 2X Adult 3X Adult 4X

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