VBS 2025 Registration

Guardian First and Last Name

Guardian's Phone Number

Guardian's Email Address

Child's Full Name

Child 1 Age

Child 2 Full Name

Child 2 Age

Child 3 Full Name

Child 3 Age

Child 4 Full Name

Child 4 Age

Are you a memebr of the Crowley Seventh-day Adventist Church?

Yes

Other SDA Church?

Other Christian Church?

Does your child(ren) have any food allergies? Please list your children and any allergies they have.

Medical Liability Release

I consent and give the Crowley Seventh-day Adventist Church authority and permission to select a medical treatment facility, physician, and all necessary emergency medical care required in case of an accident, emergency, or illness for my minor child.

Note: Every effort will be made to contact the parent/guardian in an emergency; however, I will hold the Crowley Seventh-day Adventist Church forever harmless for supervising all required emergency care. I will be responsible for all payments for all treatments, hospitalization, anesthesia, or surgery concerning emergency care for my minor child. I have read and understood this Medical Liability Release, fully understand its contents, and consent to conduct this transaction electronically. I attest that I have the authority to act on behalf of the minor child indicated herein. By checking the box below and by my electronic signature, I authorize the leaders of the Crowley Seventh-day Adventist Church to act on my medical behalf in case of emergency.

I consent

Photo Consent

I give permission to take photographs and/or video of my child. I grant full rights to use the images resulting from the photography/video filming, and any reproductions or adaptations of the images for fundraising, publicity or other purposes.

I consent

Your signature confirms that all information is accurate and that you have read and agreed to both consents

Signature field is empty.