VBS 2017 Registration Form - June 19-23
Mooresville ARP Church
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: _______________