VBS Registration July 8-12, 2018

Complete this form to register for our International Spy Academy! Fill out one form for each child attending. Contact Lesley Tipton with any questions at lesley@tatescreek.org.

Child First Name
Child Last Name
Age of Child
Grade Attending in Fall 2018
Parent(s) First and Last Name
Email Address
Phone Number
Names of others allowed to pick-up your child
List any Allergies or Sensitivities
Any special instructions we may need to know?

Relationship to Tates Creek

If you attend another church, which one?
If you are a guest, please tell us your address.
I, the parent or legal guardian of the participant listed on this form, certify that he/she has my full approval to participate in the Tates Creek Christian Church event. Further, I do release and hereby agree to hold blameless Tates Creek Christian Church and its employees and agents from any and every claim arising, or which may be asserted any member of my family by reason of participating in any activities associated with Tates Creek Christian Church. I also release the lessor/owner of properties on which the program is held. I agree to pay for any damages or property loss as determined by Tates Creek Christian Church. Further, I do authorize the minister or sponsor of this activity or any Tates Creek Christian Church staff member, in the event I cannot be reached by phone, to give consent to a physician and/or hospital for emergency medical or surgical treatment while attending this event. It is understood that I will assume any financial responsibility for any expense that may be incurred for said emergency treatment. Further, I authorize Tates Creek Christian Church to use photographs and video footage of the participant for promotional materials. Further, I do certify that said participant is covered by adequate accident insurance. I have read and agree to the information given in this entire form. My consent is given with the submission of this form.

Are Required Fields