VBS Registration

VBS Registration

Emergency Contact

Alternate Contact

Insurance Information

Health History

Medical and Liability Release Statement:

I understand that if medical intervention is needed, every attempt will be made to immediately contact the persons listed on this
form. If I cannot be reached in an emergency, I hereby give my permission to secure medical treatment for my child as deemed
necessary.

I understand Martensdale Community Church volunteers will take all reasonable safety precautions and I understand the possibility of unforeseen hazards and I know the inherent possibility of risk.

I agree not to hold Martensdale Community Church, its leaders or volunteers liable for damages, losses or injuries incurred by the subject of this form.

Coronavirus Notification:

If you decide to bring your child(ren) to Vacation Bible School (VBS) at the church, we ask that you notify Alex or Jenn Palmquist about any positive Covid-19 test that may occur in your household. This will allow those that work with your child to be notified of the potential exposure to the virus. Personal information will be kept confidential.

By placing your name in the E-Signature box below you agree to the terms of this document. The E-Signature Act became law in 2000. Under this law, online “electronic” signatures have the same legal status as a written signature.

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VBS