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VBS Waiver Form
Please fill out this form to complete the VBS waiver.
✕
Child's First Name
Child's Last Name
Child's Age
Please list any allergies or medical conditions
Add another child
Parent's First Name
Parent's Last Name
Parent's Email
Parent's Phone Number
Emergency Contact First Name
Emergency Contact Last Name
Emergency Contact Phone Number
I consent to my child's/children's participation in the VBS program.
Yes
No
I authorize the VBS staff to seek emergency medical treatment for my child/children if necessary.
Yes
No
By signing this form, I agree to release and hold harmless the VBS program, staff, and volunteers from any claims or liability arising from my child's/children's participation.
Signature
I agree to sign this form electronically.
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