First, tell us about yourself:

Parent Information

Children may only be picked up by the Parent/Guardian named above or another adult over 18 years of age whose name and contact information is listed below.  To make changes to your pick-up list in the future, please contact

Please read the information below and check the electronic signature box indicating your agreement.

This HOLD HARMLESS AGREEMENT (this “Agreement”) is made effective on June 25, 2018 by and between the Christian and Missionary Church of White Plains dba Ridgeway Alliance Church (hereinafter, “RAC”), of White Plains, New York, and (Parent/Guardian Named Above), of (City Named Above), (State Named Above), sometimes individually referred to as “Party” and collectively referred to as the “Parties.”

WHEREAS, “Party” desires to hold harmless “RAC” from any Claims and/or litigation arising out of RAC’s actions in connection with Vacation Bible Camp from Monday, June 25, 2018 to Friday, June 29, 2018.

NOW THEREFORE, in consideration of the mutual covenants and conditions contained herein, “Party” and “RAC” hereby agree as follows:

Hold Harmless, “Party” shall defend, indemnify and hold harmless “RAC” from any and all actual or alleged claims, demands, causes of action, liability, loss, damage and/or injury (to property or persons, including without limitations wrongful death), whether brought by an individual or other entity, or imposed by a court of law or by administrative action of any federal, state, or local governmental body or agency, arising out of or personnel, employees, agents, contractors, or volunteers in connection with or arising out of RAC’s actions. This indemnification applies to and includes, without limitation, the expenses, and any reimbursement to RAC for all legal expenses and costs incurred by it.

Authority to Enter Agreement. Each party warrants that the individuals who have signed this Agreement have the legal power, right, and authority make this Agreement and bind each respective Party.

Amendment Modification. No supplement, modification, or amendment of the Agreement shall be binding unless executed in writing and signed by both Parties.

Waiver. No waiver of any default shall constitute a waiver of any other default or breach, whether of the same or other covenant or condition. No waiver, benefit, privilege, or service voluntarily given or performed by a Party shall give the other Party any contractual right by custom, estoppel or otherwise.

Attorney’s Fees and costs. If any legal action or other proceeding is brought in connection with this Agreement, the successful or prevailing Party shall be entitled to recover reasonable attorney’s fees and other related costs, in addition to any other relief to which the Party is entitled.

Entire Agreement. This Agreement contains the entire agreement between the Parties related to the matters specified herein, and supersedes any prior oral or written statements or agreements between the Parties related to such matters.

Severability. If any provision of this Agreement shall be held to be invalid or unenforceable, for any reason, the remaining provisions shall continue to be valid and enforceable. If a court finds that any provision of this Agreement is invalid or unenforceable, but that by limiting such provision it would become valid and enforceable, then such provision shall be deemed to be written, construed, and enforced as so limited.

Photography / Website. I understand that RAC may use VBC photographs for display within the church or on the church website.   RAC will not disclose any names associated with the photographs. If you wish to have password protected access to this portion of the website, we will provide a password where you can download photos of your child. 

Applicable Law. The laws of the State of New York shall govern this Agreement.

AGREEMENT: By signing this Electronic Signature Acknowledgment Form, I agree that my electronic signature is the legally binding equivalent to my handwritten signature. Whenever I execute an electronic signature, it has the same validity and meaning as my handwritten signature. I will not, at any time in the future, repudiate the meaning of my electronic signature or claim that my electronic signature is not legally binding.

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Tell us about your participant:

Please note that there is a registration fee of $12 per child.  Payment information can be found below.  Your child's registration will be considered complete once payment is received.  For scholarship information, please email We can't wait to have your child join us for this exciting week!

VBC is open to children aged 3 years* - entering 6th grade.  Children 0-36 months are eligible to attend the nursery if a parent is participating as a volunteer or attending the Ladies' class and should be registered as space is limited.

*If your child has completed a 2's preschool program, he/she may be registered for the preschool program instead of the nursery.

Thank you for registering! Your registration will be complete once you have paid for your registration.  The payment information will be in the confirmation email that you receive upon submitting this form.  Please look for an email from VBS PRO Support, subject: Registration Confirmation for Shipwrecked Vacation Bible Camp.

Those interested in a Scholarship, please email

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