Windborn Church

Windborn Church
Vacation Bible School (VBS) Registration

July 14--18, 2025
5:45 p.m. -- 8:30 p.m.
Kindergarden -- 6th grade

Child's Information

Child's First Name

Last Name

Birthdate

Grade Just FInished

T-Shirt Size

Child's Address

(Apartment Number)

City

State

Zip/Postal Code

Allergies

Parent's/Guardian's Information

Parents/Guardians's First Name

Last Name

Email

Phone Number

Home Church

Emergency Contact

Emergency Contact First Name

Last Name

Phone Number

Medical Information

Insurance Company

Doctor's First Name

Last Name

Phone Number

Authorization

I hereby authorize adult volunteers of Windborn Church of Rio Vista, CA, as agent(s) for the undersigned, to consent to any medical or surgical care deemed advisable by any accredited physician or surgeon in an approved emergency clinic, facility or hospital.

Yes

I further release from any liability. Windborn Church of Rio Vista, CA, and any of it’s ministries or leaders in the event of an accident during VBS and/or en-route, during and/or returning from the above mentioned event. This agreement does not apply to claims for intentional misconduct or gross negligence.

Yes

Do you give permission for images of your child, captured during VBS events through video or photo, to be used solely for the purposes of Windborn Church promotional material and publications?

Yes

No

Signature

Windborn ChurchVacation Bible School (VBS) Registration

Child's Information

Parent's/Guardian's Information

Emergency Contact

Medical Information

Authorization

Windborn Church
Vacation Bible School (VBS) Registration