Register for VBS

at Union Baptist Church

Waterford, VT

Mon Jun 23–Fri Jun 27 AT 8:45 a.m.–4:45 p.m.

Family Information

Address

Street

Street 2

City

State/Province

Postal Code

Parent/Guardian First Name

Parent/Guardian Last Name

Primary Phone

Alternate Phone

Emergency Contact

Relationship to Student

Phone Number

Alternate Pickup Name If someone other than the parent/guardian will be bringing or picking up your child(ren), please provide us with their information here.

Alternate Pickup Phone

Alternate Pickup 2 Name

Alternate Pickup 2 Phone Number

Will you be dropping off your kid(s) for early drop off? (If you're not sure, just check yes so we can be sure to have enough food)

Yes

Student Information

First Name

Last Name

Nickname/Alternate Name

Please put the Age/Grade Level that your student(s) is entering in the Fall of 2025

Age Group

Preschool 2-3

Pre-K 4-5

Kindergarden

1st Grade

2nd Grade

3rd Grade

4th Grade

5th Grade

6 Grade

Gender

Male

Female

Birth Date

Do you have friends you would like to be placed with? We will do our best to group selected friends together in the same troup, but we cannot promise all requests will be possible.

ACTIVITIES CONSENT AND RELEASE FORM CHILDREN/MINORS

This form gives your permission as the child's parent/legal guardian for them to participate in KKC 2025 PLEASE NOTE: Paperwork is only valid if it is completed by a legal guardian. Activities Consent I hereby consent and certify that my child is able to participate in all the program and activities involved with Kingdom Kids Camp. I realize my child will participate in activities in conjunction with other persons. I accept full responsibility for my child’s actions, injuries to self or other persons, and damage to personal or church property. I UNDERSTAND AND HEREBY AGREE TO ASSUME ALL OF THE RISKS WHICH MAY BE ENCOUNTERED ON SAID ACTIVITY, INCLUDING ACTIVITIES PRELIIMINARY AND SUBSEQUENT THERE TO. I do hereby agree to hold Union Baptist Church and its agents and employees, and volunteers harmless from any and all liability, actions, causes of actions, claims, expenses, and damages on account of injury to my child or property, even injury resulting in death, which I now have or which may arise in the future in connection with the activity or participation in any other associated activities. I expressly agree that this release, waiver, and indemnity agreement is intended to be broad and inclusive as permitted by the law of the State of Vermont and that if any portion thereof is held invalid, it is agreed that the balance shall, not withstanding, continue in full legal force and effect. This release contains the entire agreement between the parties hereto and the terms of this release are contractual and not a mere recital.I further state that I HAVE CAREFULLY READ THE FOREGOING RELEASE AND KNOW THE CONTENTS THEREOF AND I SIGN THIS RELEASE BELOW AS MY OWN FREE ACT. This is a legally binding agreement which I have read and understand. **Please type your electronic signature on the line below

Parent/Guardian E-Signature

PHOTO CONSENT RELEASE FORM CHILDREN/MINORS

We recognize the need to ensure the welfare and safety of all young people taking part in any activity associated with our organization. In accordance with our child protection policy we will not permit photographs, video or other images of young people to be taken without the consent of the parents/carers and children. As your child will be taking part in the event specified above, we would like to ask for your consent to take photographs/videos of the event or activity that may contain images of your child. It is likely that these images may be used as: A record of the activity or the event OR publicity material for further activities or events on leaflets/websites/magazines. We will take all steps to ensure these images are used solely for the purposes they are intended. If you become aware that these images are being used inappropriately you should inform us immediately.

Parent/Guardian Consent for Video/Photo

I DO consent to having my child photographed or recorded for this event.

I DO NOT consent to having my child photographed or recorded for this event.

FOOD + MEDICATION ALLERGIES

This section asks about any food allergies your child may have so we can plan for KKC.

Food Allergies

Details

If your child has FOOD allergies, do you plan to send them to KKC with their own lunch/snacks?

Yes

If yes, please provide us with the names of the medications the child has allergies to and known reactions. Medication Allergies

Details

MEDICAL INFORMATION

Parents/guardians requesting medical attention (until emergency responders arrive) or medication administration to their child while at Kingdom’s Kids Camp shall provide the program with appropriate written authorization(s) and the medication before any medications are administered. Medications must be in the original container and labeled with child’s name, name of medication, directions for medication’s administration, and date of the prescription. All unused medication shall be destroyed if not picked up within one week following the child’s departure at the end of KKC.

Primary Care Physician Name

Primary Care Physician Phone Number

MEDICAL ATTENTION

Medical Concerns

Details

Medical

I DO want medical attention (until emergency responders arrive) or medication given to my child while at Kingdom's Kids Camp.

I DO NOT want medical attention (until emergency responders arrive) or medication given to my child while at Kingdom's Kids Camp.

MEDICATIONS

This child has medication that will need to be given during KKC. Please provide the name of the medication and dosage

Details

Is this Medication a Controlled Substance?

Yes

Is this medication to be self-administered by the child?

Relevant side effects of medication

Plan of Management for side effects

PARENT/GUARDIAN MEDICAL & MEDICATION ADMINISTRATION SIGNATURE

Name of Parent/Guardian Authorizing Administration of Medical Care or Medication as described and directed via questions in the Food Allergy, Medical Care, and Medication sections.

Parent/Guardian Medication E-Signature

RIVER OF LIFE CONSENT FORM

On Friday, June 27th we plan to take all campers who have consent to go with us to River of Life Camp/Gloryview Ranch in Irasburg, Vermont. We are still working out the details of this field trip with the camp. Last year our students got to play games, went on a tour of the camp, and went on a trailer ride drawn by horses. If you will allow your camper to go, please let us know below. We will have a hard copy of the paperwork needed for you to sign on the first day of registration. *PLEASE NOTE THAT IF YOU HAVE PRESCHOOL OR PRE-K CAMPERS, WE DO NOT BRING THEM WITH US TO RIVER OF LIFE CAMP. THEY ARE THE ONLY CAMPERS ALLOWED TO STAY ON CAMPUS PAST NOON UNTIL THEY ARE PICKED UP AT THE END OF FRIDAY.*

Consent

I DO allow Union Baptist Church to transport my child to and from River of Life Camp on Friday, June 27, 2025.

I DO NOT allow Union Baptist Church to transport my child to and from River of Life Camp on June 27, 2025. I will make sure my K-6 student is picked up by noon that day.

My Camper is in Preschool or Pre-K

Additional Comments

I have more students to register

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