For Adult Completing this Registration

First Name

Last Name

Preferred/Nickname

Email

Phone Number

Can you receive texts via this phone number?

Yes

No, but I have a cell

No, I have no means to receive texts

Cell Number

Have you previously given us your home address?

Yes

No

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Have you previously submitted details about the children in your household (in K - 5th grade this fall) that would like to attend VBS?

Yes

No

About the Child Attending

First Name

Last Name

Birthdate

Grade

Allergies or health concerns to be aware of?

Salvation Status

Yes

No

Add a note or ask a question...

More about this child's salvation status

How did you hear about this event?

Do you attend church, and if so, where?

Waiver & Release

Parent/Guardian Consent
Release and Indemnification

Releasor certifies that he/she/child is physically and emotionally able to participate in the listed Event/Activities.
Releasor consents to the participation of himself/herself/child in listed Event/Activities.
Releasor certifies that he/she executes this release freely, voluntarily, and after sufficient review.
Releasor certifies and he/she has the authority to release Calvary Baptist Church (CBC) from any and all claims and has not transferred such authority to any other person.
Releasor acknowledges that there are inherent risks involved in certain ministry and athletic events.
Releasor authorizes the agents of the CBC to make emergency medical decisions on behalf of him/her/child in the event he/she/child is unable to make such decisions or the Releasor cannot be reached. Releasor acknowledges that he/she will ultimately be responsible for the cost of any medical care provided to Releasor/child.
Releasor agrees to release and indemnify CBC, its pastors, trustees, officers, directors, employees, agents, and volunteer workers from any and all liability for injury, loss, or damage to person or property that may occur during the course of his/her/child’s involvement in the Event.
This Release does not extend to claims of intentional acts, gross negligence, or willful or wanton conduct arising from Releasor’s/child’s participation in above listed Event and Activities. Releasor agrees to attempt to settle all such claims through good faith negotiation with CBC. If good faith negotiation fails, Releasor agrees to attempt to settle all such claims through mediation with a professional mediator. If mediation fails, Releasor agrees to that the laws of the Commonwealth of Virginia shall govern, and the jurisdictional forum shall be the Commonwealth of Virginia.

I, the Releasor agree to the above Release and Indemnification

I Agree

I Do Not Agree

Photo Release
CBC may from time to time record video or images of my children participating in activities run at CBC event(s). These videos and images may be used for promotional purposes in printed material or on the Calvary Baptist Church website. By your children attending CBC activities, you consent to CBC taking videos and images and using and disclosing them for such purposes.

Photo Consent

I Consent to the Photo Waiver

I DO NOT Consent to the Photo Waiver

I ONLY Consent to the Photo Waiver For SOME of These Children

I DO NOT Consent to the photo waiver for