Child Signup Form for VBS: Camp Chaos! August 6 & 7
August 6 & 7 from 5:30 to 7:30 PM for rising 1st-6th graders | Please fill out this form and click submit.
Child Information
Name
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Nickname
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Grade entering in Fall 2025
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Birthdate (ex. 3/7/15)
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Allergies
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T-shirt size
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Please select one option.
Youth M
Youth L
Youth XL
Adult S
Adult M
Adult L
Adult XL
Adult 2XL
Adult 3XL
Additional information about your child that we should know
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Child Pick-Up Consent
My child will be picked up by
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Cellphone # of adult picking up my child
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Parent/Guardian Information
Guardian Name 1
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Email Guardian 1
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Emergency Contact
Emergency Contact Name 1
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Emergency Phone 1
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Relationship Emergency Contact 1
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Photo Release
I agree that St. Paul’s United Church Yes of Christ may photograph and record my and my family members’ (partner and children/dependents, for example) likeness and activities (Images) during church-related activities. I grant the following rights to St. Paul’s United Church of Christ: permission to use and re-use, publish and re-publish, and modify or alter the Image(s) taken during the shoot. Use of the Images for editorial, commercial, trade, advertising, and any other purpose may be done in any medium now existing or subsequently developed, on the church website and on the internet, and worldwide in perpetuity for the purposes stated above. I waive my right to inspect or approve any editorial text or copy that is used in connection with the Images and release and discharge St. Paul’s United Church of Christ from any and all claims arising out of use of the Images for the purposes described above, including any claims for libel, invasion of privacy, or other tortuous act. I have read the foregoing. I fully understand its contents, understand that this agreement does not expire, and confirm my agreement by signing below. I am over the age of 18 and have legal capacity to sign the release by typing my name
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Please select all that apply.
Yes
No
Parent/Guardian Signature
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Liability Release
The undersigned does hereby give permission for my child (“Participant”), to attend and participate in St. Paul’s United Church of Christ’s VBS in August 2025. LIABILITY RELEASE: In consideration of St. Paul’s United Church of Christ allowing the Participant to participate in VBS, I, the undersigned, do hereby release, forever discharge and agree to hold harmless St. Paul’s United Church of Christ, its pastors, directors, employees, volunteers, and teachers (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 which may be incurred by the undersigned and the Participant while involved in the children/youth activities and childcare. I, the parent or legal guardian of this Participant, hereby grant my permission for the Participant to participate fully in VBS. Furthermore, I, on behalf of my minor Participant, hereby assume all risk of accidental personal injury, sickness, death, damage, and expense as a result of participation in recreation and work activities involved therein. The undersigned further hereby agrees to hold harmless and indemnify said Church for any liability sustained by said Church as the result of the negligent, willful or intentional acts of said Participant, including expenses incurred attendant thereto.
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Submit
Description
August 6 & 7 from 5:30 to 7:30 PM for rising 1st-6th graders
Please fill out this form and click submit.
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