Calvary Chapel Summerviille - VBS Registration

First Name

Last Name

Directions
Part 1 (Attendees information) and part 2 (photo/video consent form) are required.

Part 3 (EpiPen/inhaler/medical VBS consent form) should only be filled out if your child has a condition we need to be aware of. NOTE - if your child DOES NOT have a medical condition, you will still need to check the appropriate box and sign electronically.

Part 1: Attendees information

Child's First Name

Child's Last Name

Child's Age

Add Second Child

Add child

Child's First Name

Child's Last Name

Child's Age

Add Third Child

Add child

Child's First Name

Add Child

Child's Age

Add Fourth Child

Add Child

Child's First Name

Child's Last Name

Child's Age

Add Fifth Child

Add child

Child's First Name

Child's Last Name

Child's Age

Add Sixth Child

Add child

Child's First Name

Child's Last Name

Child's Age

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email

Parent/Guardian Phone Number

Church Home

Emergency contact information

First Name

Last Name

Phone Number

Relationship to your child

To better serve your child, please use the space below to let us know if there are any special considerations cognitively or emotionally we should be aware of. Know that this information will be held in the strictest confidence and only shared on a "need to know basis". Thank you.

Special considerations

Part 2: Photo/video consent form

As part of our Vacation Bible School (VBS) program, we may take photographs and/or videos of participants to capture the fun and meaningful moments throughout the event. These images may be used for church-related purposes, including but not limited to:

Church presentations or bulletins
Promotional materials for future VBS programs
Social media posts or website content

By signing below, you give Calvary Chapel Summerville permission to photograph and/or record your child during VBS activities and to use these photos/videos for the purposes listed above.

Please check a box

I consent to the use of photos/videos of my child/children as described above.

I do not consent to the use of photos/videos of my child/children.

Parent/Guardian Signature

Part 3: EpiPen/Inhaler/Medical
VBS Consent Form (if applicable)

The safety and well-being of your child is the top priority at Calvary Chapel Summerville. To ensure we can provide the appropriate care in the case of an emergency, please complete this consent form for your child to carry and or use an EpiPen or inhaler or take any prescribed medication during Vacation Bible School (VBS).

Child's First Name

Child's Last Name

Allergy/Condition requiring EpiPen or inhaler

Please indicate which item your child is authorized to carry

EpiPen

Inhaler

Other medication (provide information below)

My child does not have a pre-existing medical condition

Type of medication

Dosage instructions

When to administer (specific symptoms or triggers)

Additional instructions (if any)

Second Child's First Name

Second Child's Last Name

Allergy/Condition requiring EpiPen or inhaler

Multiple Choice

EpiPen

Inhaler

Other medication (provide information below)

Type of medication

Dosage instructions

When to administer (specific symptoms or triggers)

Additional instructions (if any)

I understand that VBS staff and volunteers will take all reasonable precautions to ensure the safety of my child, and release Calvary Chapel Summerville from any liability related to the administration of the medication.

Thank you for ensuring we have the necessary information to keep your child safe during VBS. If you have any questions or specific concerns, please contact Joanna Zantow at 732-675-4938.

By signing below, I grant permission for my child to:

Carry their EpiPen/Inhaler during VBS
Self-administer the medication if needed (age-appropriate and trained)
Have the medication administered by trained VBS staff or volunteers if my child is unable to self-administer

Consent and Acknowledgement

Parent/Guardian Signature

comnplete the form below to register your child for "The Great jungle journey"

Part 1: Attendees information

Part 2: Photo/video consent form

Part 3: EpiPen/Inhaler/Medical
VBS Consent Form (if applicable)

Consent and Acknowledgement

About

Service Times

Follow Us

comnplete the form below to register your child for "The Great jungle journey"

Part 1: Attendees information

Part 2: Photo/video consent form

Part 3: EpiPen/Inhaler/MedicalVBS Consent Form (if applicable)

Consent and Acknowledgement

About

Service Times

Follow Us

Part 3: EpiPen/Inhaler/Medical
VBS Consent Form (if applicable)