First United Methodist Church of Titusville
321.269.7631
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NARNIA
HEAR THE LION ROAR!
FUMC Vacation Bible School
July 3rd - 7th
9am-noon
FREE
*no bible school July 4th,
Join us for a church wide 4th of July cookout!
Everyone is welcome!
Narnia Vacation Bible School
Registration & Waiver
Waiver MUST be filled out by legal guardian*
Child's Information
*
Indicates required field
Child Name
*
First
Last
Gender
*
Male
Female
Birth Month
*
January
February
March
April
May
June
July
August
September
October
November
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Birth Year
*
2005
2006
2007
2008
2009
2010
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School
*
Grade Level
*
Address
*
Line 1
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State
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Child's Health History
Check any that apply
*
Frequent Ear Infections
Heart defect/Disease
Seizures
Diabetes
Asthma
ADHD
Check any that apply
*
Bleeding Disorders
Mononucleosis
Downs Syndrome
Autism
Other (Please specify below)
other
*
Allergies (Specify below)
*
Chronic or recurring illness or medical condition
*
Dietary restrictions
*
Current Medications (list prescription, Over the counter & herbal)
Medication & reason for taking
*
Any other information you feel the leader/teachers should know in advance:
*
Parent/Guardian Information
Parent/Legal Guardian Name
*
First
Last
Relation to child
*
Phone Number
*
Parent/Guardian Email *
*
Alt. Contact Name
*
First
Last
Relation to child
*
Phone Number
*
Waiver
FUMC is not responsible for the loss or theft of personal belongings.
Misconduct may result in transportation home from an activity. A dismissed for a disciplinary reason will not receive a refund of the activity fee.
I understand and authorize that my child's image may be photographed or filmed and used in video presentations, Children/youth ministry Facebook, and First United Methodist website.
My child may be photographed
*
Yes
No
I hereby take the following action for my child, myself, my executors, administrators, heir, next of kin, successors and assigns: A)
I waive, release, and discharge
from any and all claims or liabilities for death or personal injury damages of any kind, which arise out of or relate to my child’s participation in FUMC’s activities, the following person, or entities: FUMC, it’s Senior Pastor and Associate Pastors, Elders, employees, volunteers, representatives, subcontractors and agents of any of the above: B
) I agree not to sue
any of the persons or entities mentioned above for any of the claims or liabilities that I have waived, released or discharged herein except in the case of gross negligence in the part of FUMC, FUMC’s staff or volunteers and: C)
I indemnify and hold harmless
the person or entities mentioned above from any claims made or liabilities assessed against them as a result of my child’s actions.
I hereby assume the risks of my child participating in all FUMC ministries activities
I hereby agree to all the above First United Methodist Waiver and Release Form Liability conditions.
*
Yes
No
I confirm that I am a legal guardian of the Child listed
*
Yes
No
Submit