2023 Center Place Vacation Church School

Please click here to download our Parent Information Sheet.

Youth's Name

Youth's Date of Birth

Youth's Current Age:

Grade entering in the fall

Youth's Address

Legal Guardian's Name & Phone

Legal Guardian Email

This address will receive a confirmation email

Emergency Contact Name & Relationship:

Emergency Contact Phone:

Is the youth a Remnant Church member?

Yes No

If you are the friend, whom did you come with?

What t-shirt size do you need?

Health Questionnaire

List any allergies the camper has (Example: Penicillin, Sulfa, Latex, Peanut Butter, Bee Stings, etc.)

List any Medications the Camper currently takes, dosage and frequency (medications must be in original Rx bottle for camp nurse to administer)

Medical History Other (include surgeries)

Immunizations Current?

Yes No

Participation Consent & Emergency Contact Information

During our VCS activities, we will be taking photos and videos of the things the children are doing. Some of these may be used in future Church publications or broadcasts. By selecting

Yes No

Please type your name to serve as electronic signature for acceptance to this waiver: We, the undersigned parents/guardians consent for our above named child to represent the Church in any and all activities. We also give consent for our child to be transported to said activity and will not hold The Remnant Church of Jesus Christ of Latter Day Saints responsible in case of accident or injury while en route to or from said activity. We hereby agree to hold the Church, its employees, agents, representatives, leaders and volunteers harmless from any and all liability, action, causes of actions, debts, claims or demands of every and any kind and nature whatsoever which may arise by or in connection with participation by my child/ward in any activities related to the activity titled above. If we cannot be reached and in the event of emergency, we also give our consent for the Church, sponsors, or leaders to obtain through a physician or hospital of its choice, such medical care as is reasonably necessary for the welfare of the individual if he/she is injured in the course of the activity of The Remnant Church of Jesus Christ of Latter Day Saints titled above.

Today's Date:

I hereby certify that I am at least 18 years of age and acting as legal guardian for registered youth.

Yes No

I give permission for my child named on this form to attend Vacation Church School at the Gathering Place in Independence. I will pick my child up at 11:30am each day.

Guardians Initials:

2023 Center Place Vacation Church School

Description

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