VBS 2026 - Illumination Station

Child's Information:

First Name

Last Name

Birthdate

Age

Grade completed

Is there a friend (close in age) that your child would like to be in a group with?

Medical

Medicare #

Medicare Expiry

Any allergies/special medications?

Any Medical or Emotional Needs we should be aware of:

For any children with special food needs: We will let you know what the snack will be each day, and if there is an issue with the food for your child, you may be required to send an appropriate snack for that day. Our team leaders and snack team need to be aware of the allergy and help remind your child to take appropraite precautions.

Any additional notes you think we should be made aware of

Parent/Guardian Information:

Name of Parent(s)/Guardian(s):

Address

This address will receive a confirmation email

Phone

Alternate Contact Person:

Name

Relationship to child

Phone

Photography/Videography consent

Do you give permission for pictures of your youth to appear on our church website, facebook or other social media pages, and/or church presentations and newsletters? *

Yes No

Other

I consent to being contacted about other activities or events through First Baptist Moncton.

Yes No

Medical Waiver

I understand that:

With all active events there is some degree of injury risk. I agree that my child participates in this event at their own risk. I will be responsible for any costs incurred on behalf of my child due to any injury, medical emergency, accident or misdemeanour whilst attending First Baptist Moncton sports events.

I accept all reasonably foreseeable risks associated with First Baptist Moncton VBS, including loss or damage to personal property or personal injury sustained by my child. I agree to indemnify First Baptist Moncton should there be any mishap as a result of my child’s participation.

I consent and authorize First Baptist Moncton, where it is impractical to communicate with me, to arrange for medical treatment and/or an ambulance for my child as deemed necessary.

I declare that all information provided in this form is true and correct and that typing my name below signifies my legal signature.

Parent/Guardian Signature

Date

VBS 2026 - Illumination Station

Description

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