VBS Summer 2023 – The Epworth Foundation

CHILD INFORMATION

Child's Name *

First

Last

Nickname

Date of Birth *

Grade *

Sex *

Female
Male

ADDITIONAL CHILDREN

2nd Child? *

Yes
No

PARENT/GUARDIAN INFORMATION

Parent/Guardian's Name *

First

Last

Address *

Address Line 1

City

State

Zip Code

Best Phone # *

Email *

EMERGENCY CONTACT

Emergency Contact's Name *

First

Last

Best Phone # *

Other Phone #

Food Allergies or Restrictions *

CHILD(REN) PICKUP

Do you approve of someone else picking up your child(ren)? *

Yes
No

RELEASE FORMS

Media Release Form *

By checking this box I acknowledge I have read all the terms and conditions below.

I understand that the volunteer photographers and/or film crews may sometimes be present to photograph or film the summer camp, field trips, and the final presentation. I hereby give my permission for promotional photographs and film and/or film footage, which may include my child, to be used for promotional and solicitation purposes and also in film festivals, television, newspapers, magazines, and press releases on the Church website and other websites related to the church, Facebook/Instagram or any other media deemed appropriate by Epworth United Methodist Church & The Epworth Foundation. Since participation is voluntary, neither the minor children nor myself will receive financial compensation.

PLEASE NOTE: We reserve the right, at our sole discretion, to change, modify or otherwise alter these Terms and Conditions at any time. Unless otherwise indicated, amendments will become effective immediately. Please review these Terms and Conditions periodically.

Multiple Choice *

I Approve!
Please do NOT photograph my child. (If this box is selected, we request you notify all staff, instructors, and volunteers in advance and that your child knows why they will not be included in group photos)

Signature *

Print Name *

First

Last

Today's Date *

Medical Release Form

Check any that apply to your child. With awareness of your child’s needs, staff may be able to modify activities and techniques for inclusiveness prior to the start of the camp. *

No specific medical or behavioral condition
Any physical, emotional, or behavioral conditions, including cognitive, LD, ADD, ADHD, or autism requiring medication, treatment, special restrictions, or considerations while at camp (if checked, please specify below)
List activities from which the camper should be exempted for health reasons or require special accommodations (if checked, please specify below)

Please note that it is your responsibility to supply any necessary medical equipment that relates to a specific medical condition. Suppose your child needs to take medication, or you expect camp staff to dispense medication to your child during camp hours. In that case, you must also complete the separate Medication Dispensing Information, Waiver, and Release form.

Does your child require an EpiPen? *

Yes
No

If YES, you need to send one with your child every day.

Do you give Epworth United Methodist Church to give your child Benadryl if needed during a field trip? *

Yes
No

If the parent or legal guardian is not available in a case of emergency, I hereby grant Epworth United Methodist Church and The Epworth Foundation my permission to secure emergency medical treatment for my child/children. *

Yes
No

Signature *

Print Name *

First

Last

Today's Date *

Parental Consent Form

Parental Consent Form *

I hereby attest that I am the legal parent/guardian of the child/children named earlier. By submitting payment, I contest my child’s/children participation at the Epworth United Methodist Church VBS Talent Camp Summer 2023 in conjunction with The Epworth Foundation. I willingly release & hold harmless the Church, Foundation, its staff, its volunteers, and or/agents from all liabilities and any mishaps that may befall my child(ren), including, but not limited to, the activities in the classroom outside the Church and all field trips.

Number of children registering? *

ONE
TWO
THREE

Would you like to donate? *

Yes
No

Total

$0.00

Credit Card Information *

Card

Name on Card

Vacation Bible School Summer Camp

The Epworth Foundation
1865 Bruce Randolph Avenue
Denver, CO 80205

CHILD INFORMATION

ADDITIONAL CHILDREN

PARENT/GUARDIAN INFORMATION

EMERGENCY CONTACT

CHILD(REN) PICKUP

RELEASE FORMS

Medical Release Form

Parental Consent Form

DONATIONS

PEACE

PRAYER

Vacation Bible School Summer Camp

The Epworth Foundation 1865 Bruce Randolph Avenue Denver, CO 80205

CHILD INFORMATION

ADDITIONAL CHILDREN

PARENT/GUARDIAN INFORMATION

EMERGENCY CONTACT

CHILD(REN) PICKUP

RELEASE FORMS

Medical Release Form

Parental Consent Form

DONATIONS

PEACE

PRAYER

The Epworth Foundation
1865 Bruce Randolph Avenue
Denver, CO 80205