2019 Vacation Bible School Registration and Waiver Release Form
Monday, June 17th through Thursday, June 20th
6:00pm – 8:00pm nightly; Dinner at 5:30pm nightly
(Woody’s VBS Roundup)
*Parents, please have children arrive by 5:40 p.m. for Check-in/Registration
By completing this for, the parent/guardian does hereby give permission for the named children to attend and participate in Harlan Christian Church’s VBS during the period of June 17th-20th, 2019 and agree to the information documented on this page.
LIABILITY RELEASE: In consideration of Harlan County Christian Church allowing the above child(ren) to participate in Vacation Bible School activities, we (I), the undersigned, do hereby release, forever discharge and agree to hold harmless Harlan County Christian Church, its directors, employees, volunteers and agents (collectively herein the “Church”) from any and all liability, claims or demands for accidental personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the above child(ren) while involved in Vacation Bible School.
Furthermore, we (I) [and on behalf of our (my) minor child(s)] hereby assume all risk of accidental personal injury, sickness, death, damage and expense as a result of participation in activities involved therein. As well as releasing the child(ren) if necessary for transportation to and from the Vacation Bible School location. We(I), the undersigned, do hereby release, forever discharge and agree to hold harmless Harlan County Christian Church, directors, employees, volunteers and agents from any and all liability, claims or demands for accidental personal injury in the process of transportation.
MEDICAL TREATMENT PERMISSION: We (I) authorize an adult, in whose care the minor has been entrusted, to consent to any emergency x-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment and hospital care, to be rendered to the minor under the general or special supervision and on the advice of any physician or dentist licensed on the medical staff of a licensed hospital or emergency care facility. The undersigned shall be liable and agree(s) to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child or youth pursuant to this authorization.
Harlan Christian Church Phone: (606) 573-1314 130 South 1st Street Email:
Harlan, KY 40831