2023 VBS Registration

June 12-16 2023 9am-12pm

2023 Stellar Community VBS Registration
Hosted at Gibsonburg Community Church - Trinity Campus, 200 E. Madison Street, Gibsonburg
3 year old’s—8th. Grade (3 year old’s must be potty trained and turned 3 by Jan. 1st.)
5th-8th grade youth will experience their own adventure after the opening at Gibsonburg Community Church, 795 West Madison St. (they will return by the end of closing @ Gibsonburg Community Church - Trinity Campus)

2023 VBS Registration

* Indicates required field

Name *

First

Last

Grade going into this fall *

T-Shirt Size. MUST be registered by May 4 to receive shirt *

Birthday *

Age *

Parent/Guardian Name *

Home Address *

City and zip code *

Home Phone *

Emergency contact person *

Cell Phone *

Emergency contact phone number *

Home Church *

Email Address *

Alternate People that are allowed to pick up your child * *

Allergies or other medical conditions (this will be listed on their name tags) *

I give permission for my child to be photographed and videotaped during church activities. My child's image may appear in print online promoting the church's activities. I understand my child's name will not be used to identify my child * *

For Youth going into 5th-8th grade, I am giving my permission for transportation to and from Gibsonburg Community Church, 795 W. Madison Street by adult chaperones. Please enter Parent/Guardian Name * *

PARTICIPATION AGREEMENT I acknowledge that participation in Vacation Bible School involves risk to the participant (and to the participant’s parents or guardians, if the participant is a minor), and may result in various types of injury including, but not limited to, the following: sickness, exposure to infectious/communicable disease, bodily injury, death, emotional injury, personal injury, property damage, and financial damage. In consideration for the opportunity to participate in the activity described above (the “activity”), the participant (or parent/guardian if the participant is a minor) acknowledges and accepts the risks of injury associated with participation in and transportation to and from the activity. The participant (or parent/guardian) accepts personal financial responsibility for any injury or other loss sustained during the activity or during transportation to and from the activity, as well as for any medical treatment rendered to the participant that is authorized by the sponsor or its agents, employees, volunteers, or any other representatives (collectively referred to as the “activity sponsor”). Further, the participant (or parent/guardian) releases and promises to indemnify, defend, and hold harmless the activity sponsor for any injury arising directly or indirectly out of the described activity or transportation to and from the activity, whether such injury arises out of the negligence of the activity sponsor, the participant, or otherwise. If a dispute over this agreement or any claim for damages arises, the participant (or parent/guardian) agrees to resolve the matter through a mutually acceptable alternative dispute resolution process. If the participant (or parent/guardian) and the activity sponsor cannot agree upon such a process, the dispute will be submitted to a three-member arbitration panel for resolution in accordance with the rules of the American Arbitration Association. I have read the PARTICIPATION AGREEMENT * *

Yes

Submit