Summer Slam Registration – Hanover Missionary Church

Please fill out the form below to register your child for our SUMMER SLAM VBS, happening August 19-23, 2019 at Hanover Missionary Church.

Child's Name *

First

Last

M/F

Child's Date of Birth *

Month/Day/Year

Address (Number/Street/Town/Postal Code)

Parent/Guardian Name *

First

Last

address is the same as child

Address if different from child

Home Phone *

if you don't have a home phone, complete with your cell number

Cell Phone

Home Church (if applicable)

Email *

Name of Emergency Contact (if necessary) *

First

Last

Emergency Contact Phone Number(s) *

Emergency Contact's Relation to Child *

My child has allergies, health concerns, or is special needs *

Please explain any other health concerns or relevant information

I give permission for my child to be included in photographs and/or videos that may be taken and may be published in HMC publications, website, Facebook page, Twitter, local newspaper, etc. I hereby give permission for my child's photograph to be used. *

I give permission for my child to participate in the HMC SUMMER SLAM VBS program and herby release, discharge, and agree to indemnify and hold harmless, HMC, its members, directors, officers, and other leaders or volunteers or any other person entity associated with HMC and its programs from any and all claims, demands, and actions or cause of action, howsoever arising, for loss or injury suffered by my child, myself, orang member of my family. I further acknowledge and agree that participation in HMC SUMMER SLAM VBS may expose my child to the risk of injury, and by my signature below, I agree to assume such risk, the nature and extent of which I am aware. *

Signature of Parent/Guardian *

By typing your name in this box you are applying your electronic signature, making it an official document for our records.

Today's Date *