VBS | Heritage Baptist Church

Please follow the steps below to register your child(ren) for our Vacation Bible School.

Call our church office for any questions: 724-523-8820

Step 1 of 3

Parent / Guardian's Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone / Emergency Contact #(Required)

Secondary Phone #

Child / Students Name #1(Required)

First Last

Students Grade(Required)

Student's Grade Level

Child / Students Name #2

First Last

Students Grade

Student's Grade Level

Child / Students Name #3

First Last

Students Grade

Student's Grade Level

Child / Students Name #4

First Last

Students Grade

Student's Grade Level

Child / Students Name #5

First Last

Students Grade

Student's Grade Level

MEDICAL CONDITIONS TO BE AWARE OF

PHYSICAL RESTRICTIONS

INSTRUCTIONS AND MEDICATIONS

I DO NOT WISH MY CHILD TO PARTICIPATE IN THE FOLLOWING

Consent(Required)

I agree to the Consent and Release Form

I, the undersigned parent or guardian, hereby consent to my child(ren) listed above with their age(s) listed above, participating in the activities during Vacation Bible School, an activity sponsored by the Heritage Baptist Church in Jeannette, PA on July 19th-22nd 5PM-8PM and the 23rd 10AM-12PM, 2022. I certify that my child is able to participate and be photographed participating in these activities, including, bible classes, games, crafts, snacks. Photographs taken of my child during these activities may be used during the event and for promoting this event in upcoming years. If my child has medical conditions which may be relevant to a physician in the event of an emergency, I have listed them below. In the event an emergency occurs, I may be reached at the telephone number listed below. If I cannot be reached within a reasonable period of time, I hereby authorize the adult sponsor, Heritage Baptist Church, to make emergency medical decisions for my child. If there are any activities I do not want my child to be involved in, I have listed them below.

I UNDERSTAND AND HEREBY AGREE TO ASSUME ALL OF THE RISKS WHICH MAY BE ENCOUNTERED ON SAID ACTIVITIES, INCLUDING ACTIVITIES PRELIMINARY AND SUBSEQUENT THERETO. I do hereby agree to hold Heritage Baptist Church and its agents and employees, harmless from any and all liability, actions, causes of actions, claims, expenses, and damages on account of injury to my child or property, even injury resulting in death, which I now have or which may arise in the future in connection with the activity or participation in any other associated activities.

I expressly agree that this release, waiver, and indemnity agreement is intended to be broad and inclusive as permitted by the law of the State of Pennsylvania, and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue 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 a mere recital.
I further state that I HAVE CAREFULLY READ THE FOREGOING RELEASE AND KNOW THE CONTENTS THEREOF AND I SIGN THIS RELEASE AS MY OWN FREE ACT. This is a legally binding agreement which I have read and understand.