I specifically give the minor child permission to participate in the activity identified and hereby assume any and all risks associated with his participation and agree and understand that by signing this document, I expressly release and indemnify Faith Pleases God Church, Faith Pleases God Church Corporation, its officers and directors, employees, agents, representatives, or any of them, from any and all fault, blame or liability from any and all damages, injuries and expenses as may be incurred and as is described in this release.
Parent's Name*
Child's Name, Age*
Child's Name (2), Age
Child's Name (3), Age
Child's Name (4), Age
Address 1*
City/State/zip*
Telephone*
Emergency Contact Person*
Telephone*
Family Physician
Allergies/Medical Conditions?
Telephone
Signature/Initials*
Email*
I agree to the terms listed below Yes I Agree
Signature/Initials*
Signed on (date)*

I consent to the VBS leaders or adult chaperons providing any medical treatment to my child(ren) deemed necessary by them if I cannot be located and I release Faith Pleases God Church from any claims associated with the first aid, treatment or services rendered to my child(ren) during his/their participation in the activity.

I certify that my child is physically fit and is capable of participating in all activities of VBS. Please document any allergies, health conditions or any other information which the leaders should know: