ECOB Amazing Race VBS 2025

VBS 2025 0

Parent/Emergency Contact Information

First Name *

Last Name *

Relationship to Child:

Phone Number *

Home Address *

Home City *

Home State

Email Address *

Child's Information

Child #1 Information

First Name *

Last Name *

Birthdate *

Gender

Male

Female

School Grade COMPLETED: *

Allergies

Behavioral Concerns:

Do you have additional children to register? *

Yes

Child #2 Information

First Name

Last Name

Birthdate

Gender

Male

Female

School Grade COMPLETED:

Allergies:

Behavioral Concerns:

Do you have another child to register?

Yes

Child #3 Information

First Name

Last Name

Birthdate

Gender

Male

Female

School Grade COMPLETED:

Allergies

Behavioral Concerns:

Medical Liability and Photo Release Information

I grant Ephrata Church of the Brethren permission to take and publish photos of my child in print or electronic form. *

I have read and understand the above information: *

I, the undersigned parent or guardian (or self if over 21) do hereby grant permission for my child to attend all events hosted by ECOB. I hereby authorize the event staff to obtain and consent to medical treatment for my child in case of injury or illness during events. I hereby release and discharge all event staff and Ephrata Church of the Brethren and its representatives, employees, volunteer staff, and agents from any and all debts, judgments, or suits of any kind which may arise or be occasioned as a result of the participants participation in the events with Ephrata Church of the Brethren. I further acknowledge and understand that by participating in the events there is a possibility of physical illness or injury and my child (or self) is assuming the risk for such illness or injury by his/her/my participation. It is my understanding that payment of any medical bills will be paid by me or by my insurance company.

I have read and agree to the above statement. *

Optional Donation

Each Summer Ephrata Church of the Brethren sends a team of missionaries to Lighthouse Projects in the Dominican Republic. There we work on building projects such as a clean water distribution center, sidewalks, a health clinic, and a ministry campus. We help teach English as a second language, and provide a VBS for hundreds of local children too. This week, our VBS kids are learning about the culture of the DR, getting to know the missionaries who run Lighthouse, and creating items to send along with our Love DR Team later in July.

You may use the link below to donate to our mission projects. Click the "Give" button. Then please make sure to select "VBS" in the "Give to:" box.

https://ecob.church/give/

Thank you for your donation!

Date

VBS 2025 0

Parent/Emergency Contact Information

Child's Information

Child #1 Information

Child #2 Information

Child #3 Information

Medical Liability and Photo Release Information

Optional Donation