N Main VBS CHild registration

Address *
Address
Child's Gender *
Child's Birthdate *
Child's Birthdate
If you would like to be grouped with a friend your age, please type their name below. We will try our best to accommodate requests, but can not guarantee requests.
On average, how often do you attend church?
VBS Advertising *
How did you hear about VBS?
Attended Before *
Attended a Gateway VBS in the past?
Name of parent/guardian that can be reached during VBS in case of emergency.
Emergency Contact Cell# *
Emergency Contact Cell#
Name of parent/guardian that can be reached during VBS in case of emergency.
Comments regarding my child's special needs, medical history, allergies, penicillin, drug reactions, etc. which may be needed in the case of any emergency treatment: If your child has FOOD ALLERGIES, please identify them and send in their own snack each night!
Release Form *
Your child may be photographed for church and mission purposes. I (We), the undersigned parent(s) or guardian(s) of _______________________ (child's name), a minor, do hereby authorize adult volunteers of the Gateway Church as an agent(s) for the undersigned, to consent to any medical or surgical care deemed advisable by an accredited physician or surgeon in an approved emergency clinic or hospital. I further release from any liability Gateway Church, any of its ministers or leaders, in the event of an accident during this event. This agreement does not apply to claims for intentional misconduct or gross negligence.
Please type your signature of the parent/legal guardian authorizing the medical release.