Register for VBS

Family Information

Address

Primary Phone

Alternate Phone

Relationship to Student Father Mother Grandfather Grandmother Great-grandfather Great-grandmother Brother Sister Uncle Aunt Guardian Foster Parent Granduncle Grandaunt Other

Phone Number

Do you consent to your child to appearing in photographs or videos while participating in this Hamakua Baptist sponsored event?

In the event of a medical emergency, and I cannot be reached, I give permission for my child to be treated at a medical facility.

Permission Form:

I give permission for my child to attend Wonder Junction, and do hereby agree to hold Hamakua Baptist Church, and its agents and volunteers harmless from all liability actions, causes of actions, claims, expenses, and damages on account of injury to my child or property, even injury resulting in death. I expressly agree that this consent and release and indemnity agreement is intended to be broad and inclusive as permitted notwithstanding, continue in full legal force and effect as contractual, and not mere recital. I further state I HAVE CAREFULLY READ THE FOREGOING RELEASE, a legally binding agreement, AND KNOW THE CONTENTS THEREOF AND I SIGN THIS RELEASE AS MY OWN FREE ACT.

Date

Student Information

Gender

Birth Date

Age Group

Food Allergies

Details

Medical Concerns

Details

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