Child's Name *

First Name

Last Name

Parent/Guardian Name

First Name

Last Name

Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact, Name

First Name

Last Name

I have read and agree to the information in the VBS Release Form *

VBS RELEASE FORM I, the undersigned parent/guardian, do hereby grant permission for my undersigned son/daughter, to attend the community-wide VBS. In order that my child may receive the proper medical treatment in the event that he/she may sustain injury or illness during Community VBS, I hereby authorize the program volunteers, to obtain or provide medical treatment for my child for such injury or illness during the program. I hereby release the program's staff and volunteers, churches, landowners, businesses, Schleicher County ISD, and Schleicher County facilities used during this program, as well as their representatives, from any and all claims, demands, actions, or causes of action, past, present, or future arising out of any damage or injury while participating in this program. I also understand that as a participant, my child may be photographed or videotaped during the normal program activities and these photos/videos may be used in promotional material.

Read/Agree

Date *

MM

DD

YYYY