Kendall United Methodist Church REGISTRATION FOR VACATION BIBLE SCHOOL 2013

Kendall United Methodist Church
REGISTRATION FOR VACATION BIBLE SCHOOL 2013
June 10 to 14, 2013 from 9:00 am to 12:00 pm
Ages 3 through entering 5th graders
Children must be both 3 years old and fully potty-trained.
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Welcome to Everywhere Fun Fair where kids get a chance to discover God’s welcoming love. Throughout the
day, your child will participate in all their favorite VBS activities: Bible story time, music, crafts, recreation and
snack time. The activities are led by adult leaders (ringmasters) and high school volunteers (fair guides). Jesus
calls us to be neighbors who love God with their whole being. This Fun Fair adventure encourages kids to be
friendly, giving, bold, forgiving and welcoming. So, let’s be neighbors with everyone we meet!
Please make every effort to register as early as possible, as classes do fill up quickly and may be limited in size.
We will do our best to accommodate every child. Late registration may result in your child being put on a
waiting list. If you have registered and your child will be unable to attend, please let us know as soon as possible
so we can accommodate those on the waiting list. If you have any questions, please contact Alaina Lorenzo, VBS
Leader, at alaina@kendallchurch.org or 305-667-0343, ext. 2.
Please Note:
Everywhere Fun Fair CDs are available at a cost of $10 each in the Preschool Office.
Get yours now and be ready to sing!
Kendall United Methodist Church
7600 SW 104 Street
Miami, FL 33156
305-667-0343
www.kendallchurch.org
Vacation Bible School 2013
Registration Form
Child’s Information:
_________________________________________________________________
___________
CHILD’S FIRST / MIDDLE / LAST NAME
MALE/FEMALE
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NICKNAME
_____________________
AGE
__________________________________
DATE OF BIRTH
______________________________________________________________________________________________________________________
ADDRESS / CITY / STATE / ZIP
You may name ONE friend of the same age you would like to have your child with in class. This is not
guaranteed, but we will do our best. _________________________________________________________
Registration Selection:
 Quality Extended Care (QEC) from 8:00 am – 9:00 am - $5.00 per hour/per child
 Vacation Bible School Week from 9:00 am – 12:00 pm – Suggested donation of $25.00
 Quality Extended Care (QEC) from 12:00 pm – 6:00 pm - $5.00 per hour/per child for hours used;
naptime is available
Your Child’s Grade (upon entering school in the Fall):
 Pre-K 3
 Pre-K 4
 Kindergarten
 1st Grade
 2nd Grade
 3rd Grade
 4th Grade
 5th Grade
Family Information:
_______________________________________
_______________________________________
MOTHER’S NAME
FATHER’S NAME
_______________________________________
_______________________________________
HOME PHONE
HOME PHONE
_______________________________________
_______________________________________
CELL PHONE
CELL PHONE
_______________________________________
_______________________________________
WORK PHONE
WORK PHONE
_______________________________________
_______________________________________
HOME CHURCH
HOME CHURCH
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E-MAIL ADDRESS
E-MAIL ADDRESS
Allergies/Restrictions:
Please list any allergies, special medical or dietary needs, recreation restrictions or other areas of concern:
_____________________________________________________________________________________
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Medical and Emergency Information:
I hereby grant permission for the staff of this facility to contact the following medical personnel to obtain
emergency medical care, if warranted.
____________________________________
_______________________________________
DOCTOR
PHONE
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ADDRESS / CITY / STATE / ZIP
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HOSPITAL PREFERENCE
Emergency Contacts:
Your child will be released only to the custodial parent or legal guardian and the persons listed below. The
following people will also be contacted and are authorized to remove the child from the facility in case of illness,
accident or emergency, if for some reason the custodial parent or legal guardian cannot be reached.
___________________________
___________________________
___________________________
NAME
NAME
NAME
___________________________
___________________________
___________________________
RELATIONSHIP
RELATIONSHIP
RELATIONSHIP
___________________________
___________________________
___________________________
CELL PHONE
CELL PHONE
CELL PHONE
___________________________
___________________________
___________________________
HOME PHONE
HOME PHONE
___________________________
___________________________
___________________________
WORK PHONE
WORK PHONE
WORK PHONE
HOME PHONE
Consent for Photography:
I consent to allow the taking of photos or videos of my child and/or me during program activities. Photos/videos
may reveal my child’s and/or my identity without any compensation paid to my child, to me or to others. All
photos and videos may be used for educational and/or promotional purposes.
Please mark one:
 Yes, I consent
 No, I do not consent
Volunteering:
As a parent/guardian, I would like to assist the VBS ministry by participating with the following:
Note: Nursery is provided for children less than 3 years of age ONLY for parents who are volunteering their time.
 Elementary Class
 Snacks
 Friday Party
 Preschool Class
 Crafts
 Decorations
 Music
 Recreation
 Set-Up
 Storytelling
 Volunteer Lunch
 Clean-Up Crew
By signing below, you verify that all information on this registration form is complete and accurate. We
look forward to caring for your child and getting to know your family.
________________________________________________________________
_____________________
PARENT / GUARDIAN SIGNATURE
DATE
FOR OFFICE USE ONLY
__________________ _____________ ________________ ____________________________________
Registration Submission Date
Donation Amount
Form of Payment
Staff Signature
CONSENT AND RELEASE FORM
I, the undersigned, as parent and/or legal guardian of __________________________________ (hereinafter
referred to as “my child”), hereby consent to my child participating in any and all activities at Kendall United
Methodist Church and assume all risks on behalf of my child associated with said activities. I hereby certify that
my child is mentally, emotionally, and physically able and capable of participating in all activities. If my child
has any condition(s), which may be relevant to a physician in the event of an emergency, I may be reached at the
telephone number listed below. If I cannot be reached, I hereby authorize an adult supervisor to contact 9-1-1
Emergency and authorize emergency and non-emergency medical technicians and health care providers to assess
the condition of my child and render medical assistance and treatment as determined necessary by such medical
technicians and health care providers. If there are any activities that I do not want my child to participate in, I
have listed them below.
I hereby agree that the Church shall be completely absolved, released, indemnified, and held harmless from any and
all liability arising from or associated with any injury, death, obligation, liability, indebtedness, or other matter(s) of
whatsoever kind concerning or otherwise involving my child’s participation in all activities and/or any medical
services arising therefrom. I expressly agree that this release, waiver, and indemnity agreement is intended to be
broad and inclusive as permitted by the laws of the State of Florida, and that if any portion hereof is held to be
invalid, it is agreed that the balance and all remaining terms shall, notwithstanding, continue to be 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 merely a recital.
I HAVE CAREFULLY READ THE FOREGOING RELEASE, WAIVER AND INDEMNITY, KNOW THE
CONTENTS THEREOF, AND I HEREBY SIGN THIS RELEASE, WAIVER AND INDENITY OF MY OWN
VOLITION. I have been given an opportunity to discuss and review this document with an attorney of my
choice, fully understand the contents contained herein, and, thus, this documents shall not be construed against the
drafter hereof, or any parties hereto. This is a legally binding agreement which I have read and understand.
ACTIVITIES THAT I DO NOT WANT MY CHILD TO PARTICIPATE IN:
____________________________________________________________________________________
____________________________________________________________________________________
TELEPHONE NUMBER WHERE I MAY BE REACHED IN AN EMERGENCY:
___________________________________________________________________________________________
______________________________________________________________
__________________________
SIGNATURE OF PARENT OR LEGAL GUARDIAN
DATE