2025 True North VBS Registration

Parent Information

Parent Name

Marital Status

Married Single Mom Single Dad

This address will receive a confirmation email

Address

Contact Phone During VBS

Parent Location During VBS

Home Church

First Time Attending VBS at Living Word

Yes No

Child(ren) Information

Child's First/ Last Name

Gender

Male Female

Grade as of Sept. 2025(VBS is from K-6th Grade)

Date of Birth (Month & Day)

Date of Birth (Year)

Allergies/Limitations/Needs

2nd Child's First/Last Name

Gender Male Female

Grade as of Sept. 2025(VBS is from K-6th Grade)

Date of Birth (Month & Day)

Date of Birth (Year)

Allergies/Limitations/Needs

3rd Child's First/Last Name

Gender Male Female

Grade as of Sept. 2025(VBS is from K-6th Grade)

Date of Birth (Month & Year)

Date of Birth (Year)

Allergies/Limitations/Needs

4th Child's First/Last Name

Gender Male Female

Grade as of Sept. 2025(VBS is from K-6th Grade)

Date of Birth (Month & Day)

Date of Birth (Year)

Allergies/Limitations/Needs

Note any Additional Concerns or Limitations Here

Emergency Contact Information

Emergency Contact Name

Emergency Contact Relationship to Child(ren)

Emergency Contact Phone Number

The participant (or parent/guardian if participant is a minor) acknowledges and accepts the risks of physical injury that could occur with the participation in the activity described above. Except for gross negligence on the part of Living Word, the participant (or parent/guardian) accepts personal financial responsibility for any bodily or personal injury sustained during the activity. Further, the participant (or parent/guardian) releases and agrees to hold harmless Living Word, and its representatives from any liability, injury, damage loss, accidents, delay or irregularity related to the undersigned individual’s planned participation in the activity. The participant (or parent/guardian if participant is a minor) also assigns to Living Word the rights to any photos, videotape and/or sound recordings made of me by or for Living Word. I hereby authorize the reproduction, sale, copyright, exhibition and/or distribution of said photos, videotapes or sound recordings without limitation or compensation.

Agree

Electronic Signature of Parent or Guardian

2025 True North VBS Registration

Description

Please Fix the Following