VBS 2017 Registration Form - June 19-23
Mooresville ARP Church
5:45-8:30 pm

Ages 4 - Rising 6th grade

Child’s Name: __________________________________________           Age: ________
Rising Grade for 2017-2018 School Year: ____________                 Date of Birth: ____________________

Parent’s or Guardian’s Name: _____________________________________________________________

Address: ________________________________________ City, State, Zip:  ________________________

Phone # - Home: ______________  Cell: 1) ___________________           2) _________________________

Email Address: _____________________________ Church You Attend: __________________________

Emergency Contact Name (other than parents or guardians) & Phone # __________________________


Allergies or other conditions that may limit activities: _________________________________________

Liability Waiver:  In consideration of giving my permission for my child to participate in all activities of Mooresville ARP Church Vacation Bible School of Mooresville, NC, I hereby release and discharge Mooresville ARP Church, their agents, employees, and officers from all claims, demands, actions, and judgments which the undersigned now has or may have or which the undersigned’s heirs, executors, administrators, or assigns may have or claim to have against Mooresville ARP Church, its successors or assigns, for all personal injuries, known and unknown, which the above-named person has or may incur by participating in the above-described activities.

I have read this release and understand all of its terms.  I execute it voluntarily and with full knowledge of its significance.

Parent/Guardian Signature: ______________________________            Date: _______________