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Child Care Registration for VBS

  

Name: Address:    
Mother: Phone:    
Father: Phone:    
Name & Position of Volunteer:       
Allergies:   Treatment: For Reaction: 
Medications: 
   (For Doctors in Case of Emergency)
Name of Contact:         
   if Volunteer is Unavailable		 Phone:   Relationship:         

Please fill out either Part I or Part II and sign.

  Part I               PERMISSION TO TRANSPORT

I give First United Methodist Church my permission to provide transportation for my child, , to the following Hospital or Clinic

  for emergency medical care or to  for emergency dental care, or to the

 nearest available source of assistance.

 

Part II               REFUSAL TO GRANT PERMISSION

I hereby state that I do not wish for myself/ my child to be transported by Marysville First United Methodist Church or by ambulance for any medical reason.

 

Photo/Video Release Form

I hereby give Marysville First United Methodist Church permission to take photographs/video of , or photographs/videos in which he/she may be involved with others for the purpose of promoting church activities.

This includes, but not limited to, items to be put on the church’s website, DVD’s, displays during services, and postal mailings.

I hereby release and discharge First United Methodist Church from any and all claims arising out of use of the photos/videos, or any rights that I or the minor may have.

I, am of full age, or am legal representative for the person in the above regard. I have read the foregoing document and fully understand its contents and know that I may revoke it at any time in writing.

This release expires one year from date of signature.

Signature:

Date: