VBS 2024 Registration
Event Timing: June 17th-21st, 2024     @5:30-8:30pm
Event Address: 2321 NE 11th Ave, Ocala, FL, 34470
Contact us at (352)629-1880 or secretarynmbc@gmail.com
*Please complete the following form for each child individually*
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Email *
Child’s Name *
Age *
Grade Completed (if applicable)  *
Required
Allergies *
Parents/Guardian Information
Name *
Phone Number *
Address (please include city, state, & zip code)
 *
Emergency Contact(s) & Phone Number(s) *
Person(s) Authorized To Pick Up My Child *
Release of Liability:  By checking the box below, I, being the parent or guardian of the child named above, do hereby give my consent and approval for my child’s participation in Northside Missionary Baptist Church’s Vacation Bible School on June 17th, 18th, 19th, 20th, &, 21st and any activities associated therewith.  I also expressly assume all risks of the child participating in the activities, whether such risks are known or unknown to me at this time.  I further release Northside Missionary Baptist Church and its leaders, employees, volunteers, and agents from any claim that my child may have or that I may have against them as a result of injury or illness incurred during the course of participation in the activities.  This release of liability shall include (without limitation) any claims of negligence or breach of warranty.  This release of liability is also intended to cover all claims that members of the child’s family or estate, heirs, representatives, or assigns may have against this organization or its leaders, employees, volunteers, or agents.  I further agree to indemnify and hold harmless Northside Missionary Baptist Church and its leaders, employees, volunteers, or agents from any claims arising from my child’s participation in its activities, or as a result of injury or illness of my child during such activities.
 *
Required
First Aid and Emergency Medical Treatment:  I recognize that there may be occasions where the child named above may be in need of first aid or emergency medical treatment as a result of an accident, illness, or other health condition or injury.  I do hereby give permission for agents of Northside Missionary Baptist Church to seek and secure any needed medical attention or treatment for the child named above, including hospitalization, if in the agent’s opinion such need arises.  In doing so, I agree to pay all fees and costs arising from this action to obtain medical treatment.  I give permission for attending physician(s) and other medical personnel to administer any needed medical treatment, including surgery and, again, I agree to pay for the medical treatment.
 *
Required
Release to use Image and Likeness:  On occasion, Northside Missionary Baptist Church or its representatives takes photographs or makes an audio or videotape recording of children and/or adults involved in activities.  Such photographs or video records may be used by staff and participants to remember the activities and participants.  I consent to the use of any such audio or visual record of the child named above to be used, distributed or displayed as agents of Northside Missionary Baptist Church see fit.  This consent includes but is not limited to:  photographs, videotape, and audio recordings.*
 *
Don't forget, on Sunday, June 23rd, 2024, we will have a Commencement ceremony and VBS Family Day where the kids will perform all the songs they've learned and awards will be given out! We can't wait to see you! 
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