VBS 2026: Step Right Up

• • Date*
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    DD

    YYYY
  • Parents Name*
  • Phone Number*
     

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  • Emergency Contact *
  • Phone Number*
     

    (###)

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  • Address*
    Street Address*

    Address Line 2

    City*

    Province / State / Region*

    Postal Code / Zip

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    Country*
  • Your E-mail*
     
  • Child Name
  • Age and Birthday
  • Allergies / Food Restrictions
  • Child Name
  • Age and Birthday
  • Allergies / Food Restrictions
  • Child Name
  • Age and Birthday
  • Allergies / Food Restrictions
  • Child name
  • Age and Birthday
  • Allergies / Food Restrictions
• Medical/Liability Release

  By submitting this form, you are agreeing to the following:
  I understand that in the event professional medical intervention is needed for a participant in a church related activity, a reasonable attempt will be made to immediately contact the designated parent or guardian listed on this form. In the event I, or the emergency contact listed cannot be reached, I hereby give permission to the activity leader to secure medical treatment for my child as deemed necessary. Hamilton Assembly of God Church will not be financially responsible for services rendered.
  I hereby release Hamilton Assembly of God Church, it's staff members, volunteers, and all other persons associated with Hamilton Assembly of God Church from any and all liability, damages, claims, demands, actions, and causes of actions of any kind, arising out of or in any way related to any activity that my child participates in or at Hamilton Assembly of God Church.
  
  • Pictures and Social Media Release*
    Hamilton Assembly of God staff / volunteers take pictures / videos to be used for the purpose of promoting VBS on all social media platforms and church website. Please select one option.
    >I give consent for my child / childrenI do NOT give consent
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