Vacation Bible School registration 2024

Child's Name
MM slash DD slash YYYY
Parent's Name
Address
Photo Consent
: I Yes / No (check one) give my consent to Jasper United Methodist Church to use photo or video images taken of my child(ren) in church brochures, advertisements for the church, on the website, in social media, and in other church publications as they see fit. I agree to hold harmless [Name of Church] from any liability which may result from the use of said picture(s). This form will apply throughout my child(ren)’s tenure at JUMC’s Vacation Bible School. **None of the photos will be for personal use.**
Medical Treatment Permission
I authorize an adult, in whose care the minor has been entrusted, to consent to any emergency X-ray examination, anesthetic, medical, surgical, or dental diagnosis or treatment and hospital care, to be rendered to the minor under the general or special supervision and on the advice of any physician or dentist licensed on the medical staff of a licensed hospital or emergency care facility. The undersigned shall be liable and agree(s) to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child(ren) pursuant to this authorization.
Medical Insurance
Emergency Contact Name
Adult picking up child
Liability Realease Electronic Signature
LIABILITY RELEASE: In consideration of Jasper United Methodist Church allowing the above child(ren) to participate in Vacation Bible School activities, I, the undersigned, do hereby release, forever discharge, and agree to hold harmless [Name of Church], its directors, employees, volunteers, and agents (collectively herein the “Church”) from any and all liability, claims, or demands for accidental personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever that may be incurred by the undersigned and the above child(ren) while involved in Vacation Bible School. Furthermore, on behalf of my minor child(ren), I hereby assume all risk of accidental personal injury, sickness, death, damage, and expense as a result of participation in activities involved therein. As well as releasing the child(ren), if necessary, for transportation to and from the Vacation Bible School location, I, the undersigned, do hereby release, forever discharge, and agree to hold harmless Jasper United Methodist Church, its directors, employees, volunteers, and agents from any and all liability, claims, or demands for accidental personal injury in the process of transportation.