VBS Registration

Trinity Presbyterian Church, 1500 Park Blvd, West Sacramento

Monday thru Friday, June 19–23, 6-8 p.m. and Sunday, June 25 10 a.m.
Please have children arrive by 5:55 for Check-in/Registration

Registration, Medical, and Waiver Release Forms

The information below must be provided for EACH child you are enrolling.
An asterisk * denotes a required field.

* Indicates required field

Child's Name *

First

Last

Child's Address *

Line 1

Line 2

City

State

Zip Code

Country

Birthdate *

Last Grade completed *

Parent/Guardian Name *

Phone Number *

Email *

Additional Parent/Guardian Name *

Additional Parent/Guardian Phone Number *

Additional Parent/Guardian Email *

Other people authorized to pick up my child *

Does this child have medical insurance? *

Yes No

Child's Medical Insurance Company *

Policy/Group ID # *

Allergies, Medications, and/or Medical Conditions *

Liability Release:

In consideration of Trinity Presbyterian Church of West Sacramento allowing the above child(ren) to participate in Vacation Bible School activities, I, the undersigned, do hereby release, forever discharge, and agree to hold harmless Trinity Presbyterian Church of West Sacramento, its directors, employees, volunteers, and agents (collectively herein the “Church”) from any and all liability, claims, or demands for accidental personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever that may be incurred by the undersigned and the above child(ren) while involved in Vacation Bible School. Furthermore, on behalf of my minor child(ren), I hereby assume all risk of accidental personal injury, sickness, death, damage, and expense as a result of participation in activities involved therein.

Medical Treatment Permission:

I authorize an adult, in whose care the minor has been entrusted, to consent to any emergency X-ray examination, anesthetic, medical, surgical, or dental diagnosis or treatment and hospital care, to be rendered to the minor under the general or special supervision and on the advice of any physician or dentist licensed on the medical staff of a licensed hospital or emergency care facility. The undersigned shall be liable and agree(s) to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child(ren) pursuant to this authorization.

Photo/Video Permission:

Select one *

I DO I DO NOT

give my consent to Trinity Presbyterian Church of West Sacramento to use photo or video images taken of my child(ren) in church brochures, advertisements for the church, on the website, in social media, and in other church publications as they see fit. I agree to hold harmless Trinity Presbyterian church of West Sacramento from any liability which may result from the use of said picture(s). This form will apply throughout my child(ren)’s tenure at Trinity Presbyterian Church’s Vacation Bible School. **None of the photos will be for personal use.**

I hereby give permission for my child(ren) to participate in Vacation Bible School at Trinity Presbyterian Church of West Sacramento on June 19 – 23, and June 25.

Please enter the name of responsible parent or guardian below. You will be asked to sign a copy of this waiver at time of first drop-off.

Parent/Guardian *

First

Last

Submit