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Participant Registration

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St. Mark's UMC

Location

4780 E. 126th St.

Carmel, IN 46033

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Contact Jackie Rowell:

317-846-4912

jrowell@stmarkscarmel.org

First, Tell Us About Yourself:

Parent Information

PLEASE NOTE: VBS is open to campers Ages 4-Grade 5. If your child is younger than age 4, we do provide nursery care, but ONLY for the children of VBS volunteers. Please do not sign your child up for the Nursery unless you agree to volunteer for camp. Thank you for your understanding! ~The VBS Directors

First Name

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Last Name

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Contact Phone 1

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Address 1

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City

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State/Province

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ZIP/Postal Code

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Emergency Contact Name (who should be contacted if we are not able to reach the parents/guardians in an emergency situation.)

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Emergency Contact Relationship

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Emergency Contact Phone

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Alternate Pickup Name

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Alternate Pickup Phone

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Tell Us About Your Participant

First Name

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Last Name

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Grade Entering

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Gender

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Date Of Birth

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Does your child have any allergies (food or other), special needs, or medical concerns we should know about to help make VBS an enjoyable & safe experience?

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We will have special seating in a calm, quiet zone during the opening and closing assembly times. Would you like your child to be seated in this area?

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Photography Notice: Each week photographers capture moments from St. Mark’s events and programs. If you would like to request that your child’s photo not be used in print materials or on the web, please type "DO NOT PHOTOGRAPH" in the field below.

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Do you have friends you would like to be placed with? We will do our best to group selected friends together in the same crew, but we cannot promise all requests will be possible.

Friend 1 First Name

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Friend 1 Last Name

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Friend 2 First Name

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Friend 2 Last Name

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Please CHECK BOX TO AGREE to this Waiver & Release Form: WHEREAS, ST. MARK’S UNITED METHODIST CHURCH OF CARMEL, INDIANA, INCORPORATED extends to its members and the community services referred to as “St. Mark’s United Methodist Church of Carmel, Indiana, Vacation Bible Camp ("hereinafter referred to as “St. Mark's VBS"); and WHEREAS, ST. MARK’S UNITED METHODIST CHURCH OF CARMEL, INDIANA, INCORPORATED cannot administer medication, with the exception of the emergency administration of Benadryl or an EPI-PEN, or guarantee the environment to be free of all food or food substances to which children attending St. Mark's VBS may be allergic; and WHEREAS, a child attending St. Mark's VBS may have a pre-existing condition or a food or food-related allergy that may or may not have been disclosed at the time of the registration of the child for St. Mark's VBS. THEREFORE, the parties to this Waiver and Release mutually agree as follows: 1. ST. MARK’S UNITED METHODIST CHURCH OF CARMEL, INDIANA, INCORPORATED, its employees, volunteers, and other personnel, shall not be charged with the responsibility of administering any type of medication, with the exception of the emergency administration of Benadryl or an EPI-PEN as a result of an allergic reaction, to any child attending St. Mark's VBS, whether prescription medication or not. The undersigned parent(s) hereby release and forever discharge ST. MARK’S UNITED METHODIST CHURCH OF CARMEL, INDIANA, INCORPORATED and its personnel from any and all liability, or from any claims, demands, damages, actions, causes of action, or suits of any kind or nature whatsoever, known or unknown, which may be brought as a result of exposure of their child to any food or food-related agent of any nature to which the child may be allergic, during attendance at St. Mark's VBS. 2. The undersigned acknowledges that in the event their child should suffer from any food or food-related allergy, and they elect to allow their child to remain at St. Mark's VBS, the release stated above would specifically apply to each parent and to their child. 3. The undersigned acknowledges that they have completely read and fully understand the contents of this Waiver and Release and voluntarily accept and approve of its contents for the purpose of their child’s continued attendance at St. Mark's VBS. Selecting "YES" confirms my specific agreement to the terms of the waiver & release form stated herein.

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Comments

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