Registration Form - VBS 2017

Family Contact Information :


Child #1


Child #2


Child #3


Child #4


Medical Authorization and Release from Liability

As a parent/guardian of the above named child(ren), I hereby give my permission for said child(ren) to participate in VACATION BIBLE STUDY (VBS) sponsored by NORTH CITY PRESBYTERIAN CHURCH (NCPC), July 24-28,2017. Following appropriate medical consultation, i have determined that my child(ren)'s health is/are adequate to participate in all activities. I acknowledge and am aware that this program involves certain inherent risks which i accept. Should emergency medical or dental diagnosis or treatment and/or hospital care be necessary I authorize the VBS adult staff to act on my behalf and consent to appropriate diagnosis, treatment, and care pursuant to all applicable law.

I hereby release NCPC, the VBS Staff, their directors, personnel, agents, and affiliates from any actions, claims, demands, or liabilities that may arise as a result of my child's participation in VBS activities, whether arising from ordinary negligence or otherwise, and whether involving fees and expense of any kind. In the event that some other person or entity seeks compensation for these released liabilities, I or my estate, and my child's estate, will indemnify and hold harmless NCPC, the VBS Staff, its directors, personnel, agents, and affliates for all sums incurred in response to said claim.

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Don't forget to make payment to North City Presbyterian Church either with a physical check made out to NCPC (delivered to the church office during business hours) or via the PayPal links provided on the preceding VBS information page.

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