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Participant Registration

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Brownstown Christian Church

Location

703 W. Spring St.

Brownstown, IN 47220

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Contact our Children's Ministry Director:

812-358-4172

creeann@brownstownchristian.org

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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In the event of an emergency, we would first try to contact the parent/guardian listed above. Please provide a secondary emergency contact in case we are unable to reach the parent/guardian listed. Name of secondary emergency contact:

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Phone number of secondary emergency contact:

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Each night of Rome VBS you will be given a security sticker that you will need to present in order to pick up your child at the end of the night. You can give this sticker (or text a picture of it) to whoever you authorize to pick up your child. In the event that you lose this sticker or unforeseen circumstances prevent you from being able to hand it off, are there any other adults (in addition to those already listed above) that you authorize to pick up your child(ren)?

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How did you hear about our Rome VBS?

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This year we are including the required waivers as part of our pre-registration process online. Thank you for taking the time to read and sign them now so that check-in can be faster and smoother for you on the first night of Rome VBS!

PHOTO & VIDEO RELEASE AND CONSENT FORM

I herby grant permission to Brownstown Christian Church (hereafter referred to as BCC) and its employees and volunteers to take photographs and/or videos of the minor child(ren) named in this registration.

I grant permission for Brownstown Christian Church to use my child(ren)’s image, video, and voice recordings in videos and posts on social media sites and public websites including but not limited to Facebook, YouTube, and the BCC website. I also grant permission for my child(ren)’s image, video, and voice recordings to be used for promotional and commemorative projects including but not limited to content shown in BCC children’s classes, content shown in BCC live church services and online streamed services, and printed content such as promotional flyers and brochures.

I understand that my child(ren)’s name(s) will not be used in conjunction with any video or images.

I further acknowledge that I will not be compensated for these uses, and that BCC exclusively owns the rights to the images, videos, and recordings, and to any derivative works created from them.

This release is binding on me and the dependent(s) named in this registration, and I sign it voluntarily.

Signing (typing) your name below will serve as an electronic signature, and you are acknowledging that you have read and agree to the "Photo & Video Release and Consent Form" above.

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If you chose not to sign the photo & video release above, please explain below. (personal preference, child is in foster care, etc.)

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WAIVER OF LIABILITY

I herby give permission for my child to participate in VBS and other children’s ministry activities and events of Brownstown Christian Church (hereafter BCC) and to be bound by all the church policies in force.

I desire that my child participate in the full range of BCC activities. My child does not have any physical limitations.

I give permission for my child to participate in petting live animals.

I acknowledge that the natural conditions of the event and the interaction with other children and adult leaders may subject my child to a risk of injury.

I acknowledge the contagious nature of illnesses and voluntarily assume the risk that my child may be exposed to or infected by illness by participating in this event.

I, therefore, release BCC from any responsibility other than normal supervision and care. In case of accident, I will not hold Brownstown Christian Church, its board of officers, its staff, or its volunteers liable. Further, I waive any claim or cause of action against the forgoing parties, which may arise as a result of an accident, illness, or injury to my child.

In the event of accident or injury, I authorize BCC staff or BCC volunteers to provide first aid and to transport and secure medical treatment for my child.

I understand that I will be responsible for any and all costs related to medical treatment and/or hospitalization.

I understand that BCC, its board of officers, its staff, or its volunteers will not be held responsible for any articles lost, stolen, or left at the church.

I understand it is my responsibility to inform, both verbally and in writing, the appropriate event leader or staff member of any relevant information that affects the safety of my child, including health conditions, allergies, or custody arrangements.

Signing (typing) your name below will serve as your electronic signature, and you are acknowledging that you have read and agree to the "Waiver of Liability" above.

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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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Allergies

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Medical Concerns

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Anything you'd like us to know?

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