Child's Name:
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Date of birth: January February March April May June July August September October November December 12345678910111213141516171819202122232425262728293031 200120022003200420052006200720082009201020112012 School grade this fall: Pre-SchoolKindergarten123456
Name of parent(s)/guardian(s):
Street address:
City: State: Zip:
Primary Phone #: Secondary Phone #:
E-mail address:
Any Food/other allergies or serious medical conditions?
In case of emergency contact
Other comments (note here if you want to be paired with a friend)
I hereby consent for my child/children to participate in the Vacation Bible School activities held at Church of New Hope in Stow, OH. As parent/guardian, I understand that I remain fully responsible for any liability which may result from the personal actions taken by my child/children. I release the Church of New Hope, 4415 Darrow Road, Stow, OH, and their agents and volunteers from any liability for injuries or accidents incurred by my child/children while participating in this VBS program. I give permission for my child, in case of emergency, to be taken to a physician or hospital by an adult volunteer or church staff. I understand that every effort will be made to contact me. If I cannot be reached, however, I hereby give permission to the physician selected by the adult in charge, to hospitalize and secure proper treatment, including surgery, for my child/children. Parents/guardians of participants in the VBS program are advised that photographs of participants may be taken and displayed within Church Of New Hope grounds and on Church of New Hope Social Media, or may be taken by family and friends of other participants. I hereby consent to photographic images being taken of my child.
