2026 March Break VBS Camp

Important Information for Parents & Guardians
The information you share on this form will be kept confidential and is collected to help us care for your child while they are attending VBS at Emmanuel Community Church. Any medical information provided allows our staff and volunteers to seek medical care for your child if an emergency arises. Please take a moment to complete all sections for each child. Having complete and accurate information helps us create a safe, fun, and welcoming experience for every child.

Student # 1:

Child's Name

Address

Date of Birth

Grade

Allergies?

If yes, please indicate:

To help us provide a welcoming and supportive environment, please let us know if your child(ren) have any learning needs, accommodations, or support strategies we should be aware of. If you indicate “yes,” a member of our team may follow up with you to better understand how we can best support your child(ren).

No additional information Yes (please describe below):

If yes, please describe:

Yes, I give permission for my child(ren)’s image to be used by Emmanuel Community Church No, I do not give permission for my child(ren)’s image to be used

Student # 2:

Name

Date of Birth

Grade:

Allergies?

Please describe:

If yes, please describe below:

During church programs and events, photos or videos may be taken for use on Emmanuel Community Church’s website, social media, printed materials, or other church communications. Please indicate your permission below regarding the use of photos or videos that may include your child(ren). Yes, I give permission for my child(ren)’s image to be used by Emmanuel Community Church No, I do not give permission for my child(ren)’s image to be used

Student # 3:

Name

Date of Birth

Grade:

Allergies?

Please Indicate Allergies:

If yes, please describe:

Student # 4:

Name:

Date of Birth:

Grade:

Allergies

If yes, please indicate:

Parent/Guardian Information:

Parent/ Guardian #1

Relationship to Child:

Phone

Please tell us where your Home Church is:

Parent/Guardian #2

Relationship to Child:

Phone

Emergency Contact:

Emergency Contact Name:

Relationship to Child:

Phone

Permission & Consent:

In the event of an accident or emergency, when a parent/guardian is unavailable: A representative of Emmanuel Community Church is hereby authorized to make such arrangements as they consider necessary for your child to receive medical/hospital care, including necessary transportation. Under such circumstances, we further authorize the attending physician to undertake such care and treatment of the student as they consider necessary. I understand that every reasonable effort will be made to contact the emergency contact(s) listed.

I agree & Authorize I do not agree

Waiver and Release of Liability

I, the undersigned parent or legal guardian, acknowledge that Emmanuel Community Church is committed to providing a safe and supportive environment for children and follows established policies and procedures designed to protect participants and respond appropriately in the event of an accident or emergency. I understand that participation in church programs and camps may involve activities that carry inherent risks despite reasonable supervision and safety precautions. On behalf of my child(ren), I voluntarily assume those risks associated with participation. To the extent permitted, I agree to release and hold harmless Emmanuel Community Church, its pastors, staff, and volunteers from liability for accidental injury or loss that may occur during participation in church programs or camps, provided that reasonable care and established church safety policies are followed. I confirm that I have read and understood this Waiver and Release of Liability and agree to its terms.

I have read and agree to the Waiver and Release of Liability above. (Required to complete registration)

Registration Payment:

Payment Information
We’re so excited for VBS Camp! 🎉

We’re currently finalizing how payment will be collected. Registered families will receive an email with payment details once everything is ready.

Thank you for your patience—we’re looking forward to a great week together!

Total of Registration (non-refundable)

$40.00 ( 1 Child) $80.00 (2 Children) $120.00 (3 Children) $160.00 (4 Children)

Acknowledgment

By submitting this form, I acknowledge that I have read and agree to the Waiver and Release of Liability & Consent & Permission above. I understand that Emmanuel Community Church reserves the right to interpret, modify, or update its policies and procedures as necessary.

I also understand that camp registration fees are non-refundable, as Emmanuel Community Church purchases supplies, materials, and resources in advance based on the number of registered participants. Due to these upfront costs, refunds cannot be issued in the event of absence, or withdrawal.

I confirm that I have read and understand this acknowledgment and agree to it as part of my child(ren)’s registration.

2026 March Break VBS Camp

Acknowledgment

Description

Please Fix the Following