VBC 2024 Registration for bpConnect

Name (Required)

Email Address (Required)

This form is only for the enrollment of children in Brush Prairie Church family.

Up to four children in a family can be enrolled using this form.

Child's Name (Required)

1st child to enroll

Child's grade in September, 2024 (Required)

1st child to enroll

Any food allergies?

1st child to enroll

Any medical concerns or medications?

1st child to enroll

Child's Name

2nd child to enroll

Child's grade in September, 2024

2nd child to enroll

Any food allergies?

2nd child to enroll

Any medical issues or medication?

2nd child to enroll

Child's Name

3rd child to enroll

Child's grade in September, 2024

3rd child to enroll

Any food allergies?

3rd child to enroll

Any medical issues or medication?

3rd child to enroll

Child's Name

4th child to enroll

Child's grade in September, 2024

4th child to enroll

Any food allergies?

4th child to enroll

Any medical issues or medication?

4th child to enroll

Person(s) picking up child/ren (Required)

Emergency Contact(s) and relation to child/ren (Required)

Emergency Contact(s) Phone Number(s) (Required)

Permission, Waiver and Release

In consideration for the opportunity to participate in Brush Prairie Church Vacation Bible Camp, the undersigned parent/guardian acknowledges that the participant is physically and mentally able to participate and further acknowledges and accepts the risks of injury associated with participation. The undersigned parent/guardian accepts personal financial responsibility for any injury sustained during participation. Further, the undersigned parent/guardian promises to indemnify, defend, and hold harmless Brush Prairie Church, its agents, employees, and representatives against any claim or liability arising as a result of such participation, whether such claim arises out of the negligence of Brush Prairie Church or otherwise.

Permission, Waiver and Release continued

The undersigned parent/guardian warrants that the participant has medical insurance and is under the supervision of church sponsors who are authorized to arrange for such medical and hospital treatment as deemed advisable for the health and well being of the participant. The undersigned parent/guardian understands that the participant’s personal medical insurance is primary. The undersigned parent/guardian gives permission for photos of the participant to be taken, and to be presented in various church-sponsored media including, but not limited to: photos, videos, slide presentations, newsletters, bulletins, brochures, programs, and Internet web pages.

I accept the stipulations outlined in the Permission and Waiver/Release sections above and check-in below. (Required)

I further understand that I need to check-in my child/ren each day during VBC.