Power Up! VBS Child Registration Form - New Life Kittitas

Join us August 19-23rd, 2019 from 9:00am to 12:00pm for Power Up! All Kidz entering K through entering 5th grade are invited to register below. Kids will be challenged to raise their game because knowing God and trusting in Jesus fills each of us with the Fruit of the Spirit!

Join us for free lunch in the park after VBS!

Name of Child

Address

Date of Birth

Age

Grade Entering

Parent/Guardian

Address

Phone # of where you will be accessible during VBS

Who, other than parents and emergency contact is authorized to pick your child up (if someone comes to pick up your child who is not on this list, that child will not be allowed to go with them - siblings included).

Church Attending

This address will receive a confirmation email

Emergency Contact and Phone #

Special Needs/Allergies/Other Concerns

Photography/Videotaping Release: I hereby give consent for my child to be photographed or videotaped for use by New Life Assembly, Kittitas. These pictures may be used in the slide show, social media, or in a church service. They wil not be forwarded to any third party. I Agree

Medical Release: If at any time medical or first aid treatment is required due to circumstances such as accident, sudden illness or emergency, I/We authorize that this treatment may be given, including necessary anesthetic, by a private physician or hospital. I/We also consent to emergency transportation if necessary.

I agree

Waiver of Claims: I/We premit the child stated above to take part in VBS - to be held at New Life Assembly, Kittitas (and/or surrounding area) and agree to waive any claims upon NLA (or any of it's agents) in the event of injury, loss, or damage, (however caused), that may be sustained by the above-mentioned child, while taking part in the programs, and in all matters relating to the ministries organized by NLA. I/We understand the risks involved in the nature of these programs.

I agree

Questions? Contact Lorie at lorie@newlifeassembly.net. :)

Description

Please fill out this form and click submit. If you have any questions please email Lorie at lorie@newlifeassembly.net.

Power Up! VBS Child Registration Form - New Life Kittitas

Description

Please Fix the Following