Child's Name *
Child's Name
Last Grade Completed (2017-18 School Year) by Child *
Parent/Legal Guardian's Name
Parent/Legal Guardian's Name
Parent/Legal Guardian's Cell
Parent/Legal Guardian's Cell
Address *
Address
Additional Emergency Contact *
Additional Emergency Contact
Additional Emergency Contact's Cell *
Additional Emergency Contact's Cell
Authorized Individuals to Pick-Up Child
Authorized Individuals to Pick-Up Child
Authorized Individual's Cell
Authorized Individual's Cell
By this Waiver, I assume any risk, and take full responsibility and waive any claims of personal injury, death or damage to personal property associated with 2018 VBS event organized by Victory Life Baptist Church. I recognize that there are certain inherent risks associated with the above described activity and I assume full responsibility for personal injury to myself and if applicable my family members, and further release and discharge Victory Life for injury, loss or damage arising out of my family's use or presence upon the facilities of Victory Life, whether caused by the fault of myself, my family Victory Life or other third parties. I consent to the participation of the child listed on this registration form in the VBS, and agree on behalf of the above minor to all the terms and conditions of this agreement. By signing this release of liability, I represent that I have legal authority over the above minor. I understand and confirm that by signing this WAIVER AND RELEASE I have given up considerable future legal rights. I have signed this agreement freely, voluntarily, under no duress. My signature is proof of my intention to execute a complete and unconditional WAIVER AND RELEASE of all liability to the full extent of the law. I am 18 years of age or older and mentally competent to enter into this waiver.