SOUTHCOAST Church
Vacation Bible School 2025

Intake & Waiver

Participant Info




Parent/Guardian Info

Emergency Contact Info

When attempts to reach parent/guardian are unsuccessful

Person(s) Authorized to Pick Up Your Child(ren)

Other than parent/legal guardian

We must have documented permission for someone other than the parent/legal guardian to pick up the child(ren) from SOUTHCOAST Church.


Medical Release Waiver

Acknowledgement of Risk

I understand that the activities at Vacation Bible School 2025 at SOUTHCOAST Church may include, but are not limited to using outdoor play equipment, arts and crafts, games, and other physical activities. While every reasonable effort is made to ensure the safety of participants, I acknowledge that there are inherent risks associated with these activities, including the possibility of injury.

Medical Consent

I, the parent/legal guardian of the participant(s) who is a minor, hereby authorize the SOUTHCOAST Church staff, volunteers, or other assigned medical professionals to act on my behalf in the event of a medical emergency. This includes:

 1. Authorization to Obtain Medical Treatment:
    In the event of injury or illness, I grant permission for the organizers to
    provide necessary first aid and/or arrange transportation to a medical facility
    for further treatment, including hospitalization and/or surgery if deemed
    necessary by medical personnel.

 2. Release of Medical Information:
     I authorize any medical provider to release information regarding the
     participant's medical history, symptoms, treatment, and prognosis to the
     Vacation Bible School 2025 staff, insurers, and other necessary parties for
     the purpose of arranging or administering care.

 3. Cost Responsibility:
      I understand that I (and/or my insurance carrier) will be financially
      responsible for any and all medical treatment administered, including but
      not limited to ambulance service, hospitalization, physician fees, and
      medication.

Health Information

Liability Release

In consideration of being allowed to participate in Vacation Bible School 2025, I hereby release and agree to hold harmless SOUTHCOAST Church, its agents, employees, volunteers, and any affiliated entities from any and all liability for personal injury, property damage, or wrongful death arising from or any way connected to Vacation Bible School 2025 activities, except in cases of gross negligence or intentional misconduct.

Media Release

I, the parent/legal guardian of the child(ren) listed as Vacation Bible School 2025 participant(s) on this form, grant permission for SOUTHCOAST Church and its representatives to photograph, film, or record the participant(s) during the event, and to use these images or recordings for promotional or educational purposes without compensation or further consent.


Acknowledgement & Certification

I have read and fully understand this Medical/Media Release Waiver. I certify that I am the parent/legal guardian of the child(ren) named on this document, and that the information provided is accurate and complete. I also confirm that the participant(s) is physically fit to take part in Vacation Bible School activities, or that any pertinent medical conditions have been disclosed on the registration form.

By signing below, I indicate my understanding and acceptance of the terms set forth in this document.


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