Vacation Bible School Registration Vacation Bible School Vacation Bible School - "God Gave Us Christmas" Friday, December 27, 2019; 9:30 am - 3:00 pm Lunch Included Parent InformationParent Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email* Home Phone*Cell Phone*Emergency ContactSomeone to contact in the event that the parent cannot be reached.Emergency Contact Name* First Last Relationship* Phone*Number of Children Registering*Please enter a number from 1 to 4.First ChildFirst Name* First Last Child Date of Birth* MM slash DD slash YYYY Child Grade for 2019-2020 School Year* Child Allergies* If none, please say so.Child Physical Activity Restrictions* If none, please say so.Child Notes to StaffAnything we should know.Second ChildName* First Last Child Date of Birth* MM slash DD slash YYYY Child Grade for 2019-2020 School Year* Child Allergies* If none, please say so.Child Physical Activity Restrictions* If none, please say so.Child Notes to StaffAnything we should know.Third ChildName* First Last Child Date of Birth* MM slash DD slash YYYY Child Grade for 2019-2020 School Year* Child Allergies* If none, please say so.Child Physical Activity Restrictions* If none, please say so.Child Notes to StaffAnything we should know.Fourth ChildName* First Last Child Date of Birth* MM slash DD slash YYYY Child Grade for 2019-2020 School Year* Child Allergies* If none, please say so.Child Physical Activity Restrictions* If none, please say so.Child Notes to StaffAnything we should know.Participation Consent and Photo ReleaseRelease for Child / Children*Release My child has permission to take part in all Parents’ Night Out activi-ties and I will not hold Covenant Presbyterian Church, its staff, or volunteers responsible for accident claims and damages arising therefrom. I take responsibility for any medical obligations incurred during the vacation bible school. I authorize the staff to take such actions as deemed necessary for the care, welfare, and health of my child including the giving consent for medical treatment. I have read, understood and agree to the releaseSignature*Sign in the box to confirm your acceptance of the release. I understand that an electronic signature is a legal signature.Photo Release Permission Form*I understand that each event during Parents’ Night Out 2019 pictures/video will be taken of the children and activities. I give permission for my child’s photo and / or video to be included in Church publications, such as bulletin boards, Web pages, newsletters, presentations, and slide shows created by Covenant Presbyterian Church. YES NO Signature*Sign your name in the box to confirm your photo choice. I understand that this electronic signature is a legal signature.Release of Child to Non-Parent or GuardianThis form must be completed if someone other than the custodial parent or guardian will be picking up the child/children at the end of Parent's Night Out 2019. Child Name - 1 First Last Each child to be picked up must be listed.Child Name - 2 First Last Each child to be picked up must be listed.Child Name - 3 First Last Each child to be picked up must be listed.Child Name - 4 First Last Each child to be picked up must be listed.Parent's Name First Last Name of Person Picking Up Children First Last A photo ID will be required at the time of pickup.Relationship to Child Name of Person Picking Up Children First Last A photo ID will be required at the time of pickup.Relationship to Child Signature for Other than Parent Pick-upSign your name in the box to confirm other than parent pick-up. I understand that this electronic signature is a legal signature. Δ