VBS: ROCKY RAILWAY

AUGUST 9 - 13, 2021
GRADES K-6

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VBS: ROCKY RAILWAY

AUGUST 9 - 13, 2021

GRADES K-6

REGISTER HERE

VBS

MONDAY AUGUST 5TH THROUGH FRIDAY AUGUST 9TH 9AM TO 12PM  PRE-K THROUGH 6TH GRADE

Learn More

VBS-Monumental –Discovering God’s Greatness

Little Lakes Wesleyan Church VBS Registration Form

Date
My Child
has my permission to attend the following event
VBS at Little Lakes Wesleyan Church 4819 county rt 37 Honeoye NY 14471.
Event date Monday August 8th– Friday August 12th @ 1:00-4:00pm.
The person picking up my child will be
They can be reached by calling
In Case of emergency please contact
at
Child date of birth
Grade
Allergies

Consent for emergency treatment
In case of emergency I authorize consent for treatment of a minor

I, the undersigned parent or guardian of
a minor, do authorize any duly authorized employee, volunteer or other representative of Little Lakes Wesley an church as agents of the undersigned to consent for any x-ray, examination, anesthetic, first-aide, medical, or surgical diagnosis or treatment and hospital care deemed advisable by and is to be rendered under the general or specific supervision of any licensed physician and surgeon, whether such diagnosis or treatment is rendered, at the office of said physician and surgeon or at a clinic, hospital or medical facility. It is understood that this is given in advance of any specific diagnosis, treatment, or hospital care being required, but it is given to provide authority and power on the part of the aforesaid agent(s) to give specific consent to any and all such diagnosis, treatment, or hospital care which is aforementioned physician in the exercise of his or her best judgement may deem advisable. It is understood that all costs of all medical treatments/care and or emergencies will be paid by the parent or legal guardian
Consent for the event and medical treatment
Date

Consent for Medications

I, the undersigned parent or guardian of
a minor, do authorize any duly authorized employee, volunteer or otherrepresentative of Little Lakes Wesleyan church as agents of the undersigned todispense medication to my child.
My Child will need the following medication during this event

Video or Picture

May we use picture/video of your child from this event to promote the church and future activities  

Thank you! Your submission has been received!
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