Wallace VBS Waitlist Form

We are so excited that you want to join our VBS this year! While outer space is infinite, our space is limited, and right now we are full! Please fill out the below form and we will notify you if a space opens up. We are NOT able to provide day-of registration this year, you MUST be pre-registered. Please submit any questions to childrensministries@wallacepca.org

Please fill out a new form for each child you are registering.

Registration and Contact Info

Child's Full Name

Child's Age

Child's Birthdate

Grade in the Fall

Pre-K 4 Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade

Parents' First and Last Name

Parent's Email Address

This address will receive a confirmation email

Parent's Phone

Emergency Contact Number

Address

Medical, Behavioral, and Safety

Let us know about any medical conditions we need to be aware of and if you will be sending an EpiPen, inhaler, or other medication. Please label all medication with the child's name.

Let us know about any allergies your child has that we need to be aware of.

If your child has any behavioral issues that we need to be aware of, please explain. For example: difficulty with transitions, doesn't do well with loud noises or large groups, or has a specific diagnosis we need to be aware of.

My child would benefit from having specialized support from a person who can provide additional attention and strategies to help them throughout VBS due to a specific special needs diagnosis or behavior concern as listed above. (Wallace has a limited number of buddies. These will be provided on a need/first come basis according to the limits of our staffing and resources). In the event that we determine your child needs a buddy during VBS and we’re unable to provide one, we may ask for your help with pick-up to ensure their comfort and safety. Yes, my child would benefit from a one-on-one buddy.

My child has a custody concern Check if yes.

Legal Release Statement and Parent Signature

I hereby give my consent to have my minor child participate in the Wallace Presbyterian Church VBS. I recognize that there are risks involved in participating in this activity and hereby assume all risk of injury, harm, and damage to my minor child in connection with his/her participation in this activity. To the fullest extent permitted by law, I release Wallace Presbyterian Church, its trustees, officers, directors, employees, agents and representatives from any injury, harm, damage, or death which may occur to my minor child while participating in the activity and agree to save and hold harmless Wallace Presbyterian Church, its trustees, officers, directors, employees, agents, and representative from any claims arising out of my minor child’s participation in the activity. I understand that efforts will be made to contact me before treatment, but in the event, I cannot be reached in an emergency, I permit the activity leader to make the decisions necessary for treatment. I do consent to any medical, surgical, x-ray, anesthetic, or dental treatment that may be deemed necessary for my minor child. I understand that I am responsible for the health care decisions of my minor child and agree that my insurance plan is the primary plan to pay for the medical, dental, or hospital care or treatment that is given to my minor child. Any insurance policy of the church or organization sponsoring the event will be used as secondary coverage. (Type Full Legal Name)

Wallace VBS Waitlist Form

Description

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