2024 Moundridge Community VBS Registration
July 8, 9, 10, 11 - 6:00-8:30PM
(Monday-Thursday)
West Zion Mennonite Church, Moundridge. 
(101 Washington Ave.)

For children ages 3 years through entering 5th grade. If you are registering multiple children, please complete a separate form for each child. If you have questions or would like to volunteer, please contact:
Ashley Stucky - 6202454375
mcvbs2023@google.com
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Parent or Guardian Name (First and Last): *
Contact Phone #: *
Contact Email Address: *
Street Address: *
City, State, Zip Code:
 *
Child's Name (First and Last): *
Child's Age and Grade entering in the fall of 2024: *
People authorized to pick up my child: *
Allergies, Medications, Activity Restrictions, and/or Medical Conditions: *
LIABILITY RELEASE: In consideration of West Zion Mennonite Church/Associated Ministries of Moundridge allowing the above child to participate in Vacation Bible School activities, I, the undersigned, do hereby release, forever discharge, and agree to hold harmless West Zion Mennonite Church/Associated Ministries of Moundridge, its directors, employees, volunteers, and agents (collectively herein the “Church”) from any and all liability, claims or demands for accidental personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the above child while involved in Vacation Bible School. Furthermore, on behalf of my minor child, I hereby assume all risk of accidental personal injury, sickness, death, damage, and expense as a result of participation in activities involved therein. As well as releasing the child, if necessary, for transportation to and from the Vacation Bible School location, I, the undersigned, do hereby release, forever discharge, and agree to hold harmless West Zion Mennonite Church/Associated Ministries of Moundridge, its directors, employees, volunteers, and agents from any and all liability, claims or demands for accidental personal injury in the process of transportation.
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PHOTO/VIDEO PERMISSION: I give my consent to West Zion Mennonite Church/Associated Ministries of Moundridge to use photo or video images taken of my child during VBS activities in church brochures, advertisements for the church, on the website, in social media, and in other church publications as they see fit. I agree to hold harmless West Zion Mennonite Church/Associated Ministries of Moundridge from any liability which may result from the use of said picture(s). This form will apply throughout my child’s tenure at Vacation Bible School. **None of the photos will be for personal use.**

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MEDICAL TREATMENT PERMISSION: I authorize an adult, in whose care the minor has been entrusted, to consent to any emergency X-ray examination, anesthetic, medical, surgical, or dental diagnosis or treatment and hospital care, to be rendered to the minor under the general or special supervision and on the advice of any physician or dentist licensed on the medical staff of a licensed hospital or emergency care facility. The undersigned shall be liable and agree to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child pursuant to this authorization.
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Parent/Guardian Signature: *
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