Participant Registration

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First Presbyterian Church Eustis

Location

117 S. Center St

Eustis, FL 32726

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Contact Shannon Walter:

352-357-2833

shannon@fpceustis.com

First, tell us about yourself:

Parent Information

First Name

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Last Name

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Address 1

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Address 2

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City

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State/Province

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ZIP/Postal Code

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Country

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Contact Phone 1

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Contact Phone 2

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Text Message Phone

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Emergency Contact Name

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Emergency Contact Relationship

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Emergency Contact Phone

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Click here for your FREE Friends With God Kids Activity Pack

By checking the box you will be emailed your Free Friends With God Kids Activity Pack.

You are also agreeing to receive emails about family resources from Lifetree. You can unsubscribe at any time. We value your privacy. Your information will not be shared with a third party. Lifetree is a division of Group Publishing, the creators of Group VBS and other faith-building resources. Click to learn more about Lifetree.

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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Shirt Size

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Allergies

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Medical Concerns

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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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Comments

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Stellar VBS Medical/Liability Release

I agree for myself, my heirs and personal representatives, hereby freely and voluntarily assume all liabilities, risks, injuries, and hazards incidental to participation in any and all programs sponsored and/or coordinated by First Presbyterian Church of Eustis, Florida whether due to my negligence or the negligence of others including but not limited to transportation to or from said activity. I acknowledge the fact that this program may or does involve physical contact with inherent risks or other conditions where injuries may occur. I do hereby waive, release and agree to hold harmless First Presbyterian Church of Eustis, Florida, its officers, agents, employees, the organizers, sponsors, activity supervisors, co-sponsoring organizations, and participants for any claim, demand liability costs, suits, charges, or compensation for loss of injury or any kind arising out of a loss or an injury. I acknowledge that First Presbyterian Church of Eustis, Florida will not assume any costs relating to any injury while I am involved in their activities of mission, fellowship, education and worship. I acknowledge that, absent this Assumption of Risk, the First Presbyterian Church of Eustis, Florida or other sponsors of the activity would not have offered me access to this activity because of unacceptable exposure to liability claims or the expense providing a program that is risk-free.

In order to expedite the care of my (our) child named above, I (we) give permission for the appropriate medical personnel and staff to initiate treatment immediately upon arrival at the appropriate facility. I (we) agree to be financially responsible for my (our) child’s treatment. I (we) also request that I (we) (or the alternate emergency contact person listed) be notified of my (our) child’s condition and admission as soon as possible.

In the event of a life-threating accident or illness, I (we) understand that First Presbyterian Church of Eustis, Florida or its representatives or agents in charge of the activity, may contact 911 services immediately. I (we) agree to be financially responsible for my (our) child’s care and treatment.

I agree to FPCE's Medical/Liability Release

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In completing this registration form, you are giving our photographers permission to photograph your child/children while participating in activities during Stellar VBS at First Presbyterian Church Eustis. We will use these photos to promote and share the fun we are having.

Photography Acknowledgement

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