Who will pick up your child?*

Child's Gender*

Child's Birthdate (mm/dd/yyyy)*

Child's Grade (Fall 2024)*

I understand that my child(ren) may be photographed, videotaped, and/or recorded as part of VBS or other Children's Ministries activities and these photos may be included in publications, website, and other social media platforms of the First Presbyterian*

(Please add initials and date to indicate you have read and agree to this statement)

NOTE: WE ARE NOT PEANUT FREE: If your child has a food allergy, please provide your child's snack each day. *

(Please initial and date to indicate you have read this statement)

In the event that my child (listed above) becomes ill or injured on any authorized or chaperoned Vacation Bible School event, I give permission to the church and the VBS staff to take whatever steps necessary to administer first aid.*

(Please initial and date to indicate you have read this statement)

In the event that I cannot be reached, I consent to emergency treatment for my child, which may include emergency care, hospital care and the administration of drugs or medicine to be rendered to my child upon the advice of a licensed physician.*

(Please initial and date to indicate you have read the above statement)

I will not hold the church, its staff, nor its volunteers liable in the event of injury or illness involving my child, except in the case of gross negligence. *

(Please initial and date to indicate you have read the above statement)

MEDICAL INSURANCE INFORMATION: Medical Insurance Company*

Insurance ID#*

Primary Insured Name*

Insurance Group ID#*