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VBS REGISTRATION

Multi-line address
Birthday
Month
Day
Year
Child Shirt Size
Payment

PERMISSION/RELEASE I understand that in the event medical intervention is needed, every attempt will be made to contact immediately the persons listed on this form. In the event I cannot be reached in an emergency during the activity dates shown on this form, I hereby give my permission to the physician or dentist selected by the activity leader to hospitalize, to secure medical treatment, or order an injection, anesthesia, or surgery for my child as deemed necessary. I understand all reasonable safety precautions will be taken at all times by the First Presbyterian Church of Snohomish and its agents during the events and activities. I understand the possibility of unforeseen hazards and know the inherent possibility of risk. I agree not to hold First Presbyterian Church of Snohomish, its leaders, employees, and volunteer staff liable for damages, losses, diseases, or injuries incurred by the subject of this form.

PHOTOGRAPH, VIDEO, AND AUDIO MATERIAL I, the undersigned, hereby consent to the use of any videos, photographs, slides, audio clips or any other visual or audio reproduction in which I may appear by First Presbyterian Church of Snohomish in its print and online productions (including social media). I understand that these materials are being used for promotion of thechildren and youth ministry of First Presbyterian Church of Snohomish, which includes recruitment and fund raising efforts. I release First Presbyterian Church of Snohomish from any liability connected with the use of my picture or voice recording as part of any promotional, recruitment or fund raising program.

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