Illumination Station VBS Registration 2026 • Rehoboth Ministries New Covenant Christian Church

Illumination Station VBS Registration 2026

Parent/Guardian Information:

Parent/Guardian Full Name *

Relationship to Child(ren) *

Primary Phone Number *

Alternate Phone Number *

Emergency Contact Information:

Emergency Contact (Other Than Parent/Guardian) Full Name *

Relationship to Child(ren) *

Phone Number *

Child 1 Information:

Child 1 Full Name *

Allergies or Medical Conditions *

Medications (If Any) *

Age *

Gender *

Grade (Entering in the Fall) *

T-Shirt Size *

Child 2 Information

Child 2 Full Name

Allergies or Medical Conditions

Medications (If Any)

Age

Gender

Grade (Entering in the Fall)

T-Shirt Size

Child 3 Information

Child 3 Full Name

Allergies or Medical Conditions

Medications (If Any)

Age

Gender

Grade (Entering in the Fall)

T-Shirt Size

Emergency Medical Authorization and Liability Release

I understand that all reasonable safety precautions will be taken during the event. In the event of an emergency, and if neither I nor the secondary contact can be reached, I authorize any medical treatment deemed necessary by a licensed physician and/or hospital, as indicated on the registration form. I acknowledge that there may be unforeseen hazards and accept the inherent risks associated with participation in this event. I voluntarily release, waive, discharge, and hold harmless Rehoboth Ministries New Covenant Christian Church, its officers, employees, volunteers, and agents from any and all liability, claims, or demands arising from or related to injury, illness, or property damage occurring during or as a result of my child(ren)'s participation in this event, except in cases of gross negligence or willful misconduct.

I authorize Rehoboth Ministries staff to seek emergency medical treatment for my child(ren), if necessary. *

Yes, I authorize Rehoboth Ministries staff to seek emergency medical treatment for my child(ren), if necessary.

Please Electronically Sign Below

Electronic Signature *

Please Electronically Date Below

Date *