By checking this box, I agree as the parent or legal guardian of the child or (children) I have registered to:
1) Release of liability, for myself, my minor child(children) and for the child's other parent(s) and/or guardian(s), and I will assume full responsibility for any Accident/Medical insurance needed to cover my child in case of injury or illness, including, but not limited to exposure to the flu and/or Covid-19, while my child is attending Vacation Bible School (VBS),
I will not hold The Mt. Horeb Baptist Church In Gates, Oregon or any employees, volunteers, representatives, elders or members associated with The Mt. Horeb Baptist Church in Gates, Oregon is responsible in any manner for injury and/or illness. By checking this box, I hereby agree to release and indemnify the Mt. Horeb Baptist Church, in Gates Oregon, its volunteers, staff and representatives and their heirs from and against all claims, liabilities, damages to person or property arising from or in
connection with the participants in the program.
2) Consent to Medical Treatment: In the event my child becomes ill or injured, I give permission for a representative of the Mt. Horeb Baptist Church in Gates Oregon, to take whatever steps are reasonably necessary to render emergency first aid to my child.
3) Photo Release: I give permission for my child’s photo, which may be taken during any and all activities during Vacation Bible School (VBS) for publicity and promotional purposes.
List your child/children below that will be participating in VBS at the
Mt. Horeb Baptist Church.
By checking this box above I acknowledge that I have read and understood the information on this form and I give consent for my child to participate in the VBS activities during the Mt. Horeb Baptist Church in Gates, Oregon.
