VBS Registration 2023 | August 7th to 11th from 6:00 pm to 8:00pm | Ages 3 - 12

August 7-11 2023 | Please fill out this form and click submit.
Parent/Guardian Information

 
 
 
 
 
 
Emergency Contact Information (If different from above)

 
 
 
 
Child #1

 
 
 
 
 
 
Child #2

 
 
 
 
 
 
Child #3

 
 
 
 
 
 
Child #4

 
 
 
 
 
 
Child #5

 
 
 
 
 
 

* I agree that Dobbins Memorial UMC may photograph and record myself (Images) during church-related activities. I grant the following rights to Dobbins Memorial UMC: permission to use and re-use, publish and re-publish, and modify or alter the Image(s) taken during the shoot. Use of the Images for editorial, commercial, trade, advertising, and any other purpose may be done in any medium now existing or subsequently developed, on the church website, social media platforms and on the Internet, and worldwide in perpetuity for the purposes stated above. I waive my right to inspect or approve any editorial text or copy that is used in connection with the Images and release and discharge Dobbins Memorial UMC from any and all claims arising out of use of the Images for the purposes described above, including any claims for libel, invasion of privacy, or other tortuous act. I have read the foregoing. I fully understand its contents, understand that this agreement does not expire, and confirm my agreement by signing below. I am over the age of 21 and have the legal capacity to sign the release.




 Dobbins Memorial UMC Accident Waiver and Release of Liability Form


I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATION AND/OR VOLUNTEERING IN THIS ACTIVITY OR EVENT, including any risks that may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault.


I certify that there are no health-related reasons or problems which preclude the child's participation in these activities or events.


I acknowledge that this Accident Waiver and Release of Liability Form will be used by the event holders, sponsors, and organizers of the activities or events in which the child may participate and that it will govern actions and responsibilities.


I WAIVE, RELEASE, AND DISCHARGE from any and all liability arising from the negligence or fault of the entities or persons released, for death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me including traveling to and from these events.  


I INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this Dobbins Memorial UMC activities from any and all liabilities or claims made as a result of participation in these activities or events, whether caused by the negligence of release or otherwise. 


I acknowledge that these activities or events may involve risks caused by terrain, facilities, temperature, and weather condition of participants, equipment, vehicular traffic actions of other people, and lack of hydration.


I hereby consent to my child to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during these activities or events.


The accident waiver and release of liability shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.


I CERTIFY THAT I HAVE READ THIS DOCUMENT, AND I FULLY UNDERSTAND ITS CONTENT.  I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL.


 
 
 

Description

August 7-11 2023
Please fill out this form and click submit.