Calvary Memorial Church in Oak Park, IL

Vacation Bible School 2010

VACATION BIBLE SCHOOL REGISTRATION

June 21-25, 2010 (9am-Noon)

3 years through 5th Grade (just finished)

PLEASE COMPLETE ONE FORM PER CHILD

Child's Name: *

Gender: *

Female

Male

Child's T-Shirt Size: *

* T-Shirt size will be distributed AS AVAILABLE for registration after May 15.

Child's Age (June 21) *

*Children will be assigned by grade level, unless you talk to the Director, Heidi Wolfe.

Child's Date of Birth *

Child's Address: *

Child's City: *

Child's Zip: *

Parent / Guardian's Name: *

Parent / Guardian's Home Phone:

Parent / Guardian's Cell Phone:

Parent / Guardian's Email: *

Yes, I'd like to be included in Calvary Children's Ministry mailings!

EMERGENCY CONTACTS

(Different than above Parent / Guardian)

(1) Name: *

Phone: *

Relationship to Student: *

(2) Name: *

Phone: *

Relationship to Student: *

HEALTH INFORMATION

Other health problems:

Does your child have any allergies or take any medications that we should be aware of? *

Yes

If so, please explain:

VOLUNTEERING

I'd like someone to contact me about volunteering.

I will need childcare (infant - 2s)

PAYMENT

Suggested donation is $10 per child, $20 per family.

Please include payment with registration. Checks should be made payable to: Calvary Memorial Church

Emergency Release: *

Yes

In the event of an emergency, if I (we) cannot be reached at the given numbers, then I (we), the undersigned parent(s) or guardian(s) of the child listed above, a minor, do hereby authorize the volunteers of Calvary Memorial Church, Oak Park, IL as agents for the undersigned, to consent to any medical or surgical care deemed advisable for my child.

Liability Release: *

Yes

I (we) the undersigned parent(s) or guardians of the child entered above,a minor, give permission for my (our) child to participate in the above activity and release Calvary Memorial Church of Oak Park, IL, its officers, employees and agents from any liability whatsoever for any injury or death to person or loss or damage to property sustained by the undersigned for any member of his family, in attendance, and the undersigned agrees to defend and indemnify Calvary Memorial Church, Oak Park, IL its officers, employees and agents any liability or loss they might sustain by reason thereof.

Electronic Signature: *

[Organization Name]

Vacation Bible School (June 21-25)

SonQuest Rainforest

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