Scuba VBS 2024 Registration Form

Parent / Guardian Information

Name of Parent / Guardian (First and Last Name)

Name of Parent / Guardian (First and Last Name) if not already provided.

Address

Home / Cell Phone

Work Phone

Emergency Contact

Home Email

This address will receive a confirmation email

Home Church

Children Information

Total Number of Registered Children

1st Child's First & Last Name

1st Child's Birthdate (mm/dd/yyyy)

1st Child's Age (must be at least 3 and potty trained)

1st Childs Grade (Last Level Completed)

Special Needs of Child (medications, food allergies, learning disability, etc.)

2nd Child's First & Last Name (if applicable)

2nd Child's Birthdate (mm/dd/yyyy) (if applicable)

2nd Child's Age (must be at least 3 and potty trained) (if applicable)

2ndChilds Grade (Last Level Completed)

Special Needs of Child (learning disability, medications, food allergies, etc.) (if applicable)

3rd Child's First & Last Name (if applicable)

3rd Child's Birthdate (mm/dd/yyyy) (if applicable)

3rd Child's Age (must be at least 3 and potty trained) (if applicable)

3rd Childs Grade (Last Level Completed)

Special Needs of Child (learning disability, medications, food allergies, etc.) (if applicable)

Total Number of Children Being Registered

Waiver

By filling up VBS 2024 Scuba Registration Form, I, the parent/guardian of the child[ren] registered on this form, authorize above listed child[ren] to participate in Woodbridge Community Church ("WCC") Kids Scuba VBS 2024.

I understand the inherent risks in participating in WCC Kids Scuba VBS 2024 and agree to accept said risks. Further, in consideration of the participation of said child[ren] in WCC Kid's Scuba VBS 2024 program, the undersigned voluntarily accepts and assumes any and all risks relating thereto and agrees to, and does hereby release from liability, and agrees to and does hereby promise to indemnify and hold harmless WCC, its officers, directors, employees and any organization affiliated with WCC from any and all claims that the undersigned may have in connection with the participation of said child[ren] in said activities.

I give permission for photos/videos of my child captured during WCC Kids Scuba VBS program to be used for the purposes of WCC and agree to waive any rights of compensation or ownership (unless I opt out in writing).

THE UNDERSIGNED HAS CAREFULLY READ THIS RELEASE AND AGREEMENT AND UNDERSTANDS THAT IT IS AN EXPRESS ASSUMPTION OF ALL RISKS RELATING TO THE PARTICIPATION OF CHILD[REN] IN WCC’S PROGRAM AND ACTIVITIES. THIS AGREEMENT IS BEING ENTERED INTO FREELY AND VOLUNTARILY AND IS INTEDED TO AND SHALL BE BINDING ON THE UNDERSIGNED, AND THE UNDERSIGNED’S HEIRS AND LEGAL REPRESENTATIVES.

Under penalty of perjury, I herewith affirm that my electronic signature were signed by myself with full knowledge and consent and am legally bound to these terms and conditions.

Electronic Signature

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Scuba VBS 2024 Registration Form

Description

Please Fix the Following