Kendall United Methodist Church REGISTRATION FOR VACATION BIBLE SCHOOL 2013 June 10 to 14, 2013 from 9:00 am to 12:00 pm Ages 3 through entering 5th graders Children must be both 3 years old and fully potty-trained. _______________________________________________________________________ Welcome to Everywhere Fun Fair where kids get a chance to discover God’s welcoming love. Throughout the day, your child will participate in all their favorite VBS activities: Bible story time, music, crafts, recreation and snack time. The activities are led by adult leaders (ringmasters) and high school volunteers (fair guides). Jesus calls us to be neighbors who love God with their whole being. This Fun Fair adventure encourages kids to be friendly, giving, bold, forgiving and welcoming. So, let’s be neighbors with everyone we meet! Please make every effort to register as early as possible, as classes do fill up quickly and may be limited in size. We will do our best to accommodate every child. Late registration may result in your child being put on a waiting list. If you have registered and your child will be unable to attend, please let us know as soon as possible so we can accommodate those on the waiting list. If you have any questions, please contact Alaina Lorenzo, VBS Leader, at alaina@kendallchurch.org or 305-667-0343, ext. 2. Please Note: Everywhere Fun Fair CDs are available at a cost of $10 each in the Preschool Office. Get yours now and be ready to sing! Kendall United Methodist Church 7600 SW 104 Street Miami, FL 33156 305-667-0343 www.kendallchurch.org Vacation Bible School 2013 Registration Form Child’s Information: _________________________________________________________________ ___________ CHILD’S FIRST / MIDDLE / LAST NAME MALE/FEMALE _________________________________________________________ NICKNAME _____________________ AGE __________________________________ DATE OF BIRTH ______________________________________________________________________________________________________________________ ADDRESS / CITY / STATE / ZIP You may name ONE friend of the same age you would like to have your child with in class. This is not guaranteed, but we will do our best. _________________________________________________________ Registration Selection:  Quality Extended Care (QEC) from 8:00 am – 9:00 am - $5.00 per hour/per child  Vacation Bible School Week from 9:00 am – 12:00 pm – Suggested donation of $25.00  Quality Extended Care (QEC) from 12:00 pm – 6:00 pm - $5.00 per hour/per child for hours used; naptime is available Your Child’s Grade (upon entering school in the Fall):  Pre-K 3  Pre-K 4  Kindergarten  1st Grade  2nd Grade  3rd Grade  4th Grade  5th Grade Family Information: _______________________________________ _______________________________________ MOTHER’S NAME FATHER’S NAME _______________________________________ _______________________________________ HOME PHONE HOME PHONE _______________________________________ _______________________________________ CELL PHONE CELL PHONE _______________________________________ _______________________________________ WORK PHONE WORK PHONE _______________________________________ _______________________________________ HOME CHURCH HOME CHURCH _______________________________________ _______________________________________ E-MAIL ADDRESS E-MAIL ADDRESS Allergies/Restrictions: Please list any allergies, special medical or dietary needs, recreation restrictions or other areas of concern: _____________________________________________________________________________________ _____________________________________________________________________________________ Medical and Emergency Information: I hereby grant permission for the staff of this facility to contact the following medical personnel to obtain emergency medical care, if warranted. ____________________________________ _______________________________________ DOCTOR PHONE _____________________________________________________________________________________ ADDRESS / CITY / STATE / ZIP _____________________________________________________________________________________ HOSPITAL PREFERENCE Emergency Contacts: Your child will be released only to the custodial parent or legal guardian and the persons listed below. The following people will also be contacted and are authorized to remove the child from the facility in case of illness, accident or emergency, if for some reason the custodial parent or legal guardian cannot be reached. ___________________________ ___________________________ ___________________________ NAME NAME NAME ___________________________ ___________________________ ___________________________ RELATIONSHIP RELATIONSHIP RELATIONSHIP ___________________________ ___________________________ ___________________________ CELL PHONE CELL PHONE CELL PHONE ___________________________ ___________________________ ___________________________ HOME PHONE HOME PHONE ___________________________ ___________________________ ___________________________ WORK PHONE WORK PHONE WORK PHONE HOME PHONE Consent for Photography: I consent to allow the taking of photos or videos of my child and/or me during program activities. Photos/videos may reveal my child’s and/or my identity without any compensation paid to my child, to me or to others. All photos and videos may be used for educational and/or promotional purposes. Please mark one:  Yes, I consent  No, I do not consent Volunteering: As a parent/guardian, I would like to assist the VBS ministry by participating with the following: Note: Nursery is provided for children less than 3 years of age ONLY for parents who are volunteering their time.  Elementary Class  Snacks  Friday Party  Preschool Class  Crafts  Decorations  Music  Recreation  Set-Up  Storytelling  Volunteer Lunch  Clean-Up Crew By signing below, you verify that all information on this registration form is complete and accurate. We look forward to caring for your child and getting to know your family. ________________________________________________________________ _____________________ PARENT / GUARDIAN SIGNATURE DATE FOR OFFICE USE ONLY __________________ _____________ ________________ ____________________________________ Registration Submission Date Donation Amount Form of Payment Staff Signature CONSENT AND RELEASE FORM I, the undersigned, as parent and/or legal guardian of __________________________________ (hereinafter referred to as “my child”), hereby consent to my child participating in any and all activities at Kendall United Methodist Church and assume all risks on behalf of my child associated with said activities. I hereby certify that my child is mentally, emotionally, and physically able and capable of participating in all activities. If my child has any condition(s), which may be relevant to a physician in the event of an emergency, I may be reached at the telephone number listed below. If I cannot be reached, I hereby authorize an adult supervisor to contact 9-1-1 Emergency and authorize emergency and non-emergency medical technicians and health care providers to assess the condition of my child and render medical assistance and treatment as determined necessary by such medical technicians and health care providers. If there are any activities that I do not want my child to participate in, I have listed them below. I hereby agree that the Church shall be completely absolved, released, indemnified, and held harmless from any and all liability arising from or associated with any injury, death, obligation, liability, indebtedness, or other matter(s) of whatsoever kind concerning or otherwise involving my child’s participation in all activities and/or any medical services arising therefrom. I expressly agree that this release, waiver, and indemnity agreement is intended to be broad and inclusive as permitted by the laws of the State of Florida, and that if any portion hereof is held to be invalid, it is agreed that the balance and all remaining terms shall, notwithstanding, continue to be in full legal force and effect. This release contains the entire agreement between the parties hereto and the terms of this release are contractual and not merely a recital. I HAVE CAREFULLY READ THE FOREGOING RELEASE, WAIVER AND INDEMNITY, KNOW THE CONTENTS THEREOF, AND I HEREBY SIGN THIS RELEASE, WAIVER AND INDENITY OF MY OWN VOLITION. I have been given an opportunity to discuss and review this document with an attorney of my choice, fully understand the contents contained herein, and, thus, this documents shall not be construed against the drafter hereof, or any parties hereto. This is a legally binding agreement which I have read and understand. ACTIVITIES THAT I DO NOT WANT MY CHILD TO PARTICIPATE IN: ____________________________________________________________________________________ ____________________________________________________________________________________ TELEPHONE NUMBER WHERE I MAY BE REACHED IN AN EMERGENCY: ___________________________________________________________________________________________ ______________________________________________________________ __________________________ SIGNATURE OF PARENT OR LEGAL GUARDIAN DATE