We are excited about VBS this year at Five Rivers Church! This year's theme is: Shipwrecked - Rescued by Jesus.

VBS will be July 14 - 18th, 6:30 pm to 8:30pm for children 4 years old through 5th Grade. Please fill out this pre-registration form below. We will also need you to sign a permission slip when you arrive on the first day.

We look forward to having a great VBS!

VBS 2019.jpg

What: VBS 2019 - Shipwrecked - Rescued by Jesus

Where: Five Rivers Church -290 Whitehall Rd, Elkton, MD (call 410-398-4234 for info)

When: July 14- July 18, 6:30 pm - 8:30 pm

Cost: FREE! - Register below


Child's Name *
Child's Name
Gender *
Birthdate *
Birthdate
Please enter the child's birthdate
Parent/Guardian #1 *
Parent/Guardian #1
Phone *
Phone
Best Contact Number
Parent/Guardian #2
Parent/Guardian #2
Phone
Phone
Best Contact Number
Address *
Address
Medical Treatment *
In the event of an emergency, is Five Rivers authorized to approve medical treatment, including the distribution of child-appropriate over-the-counter medicines? YES or NO
Medical Insurance *
Is the child covered by personal/family medical insurance? YES or NO
Please enter Yes or No. If "Yes" please list.
Please enter Yes or No. If "Yes," please list.
Do you consent for the child's picture to be taken and used in any promotion or publication of Five Rivers now or in the future? *
Participation Agreement *
In consideration for the opportunity to participate in the above activity, the Participant (or parent/guardian if Participant is a minor) acknowledges and accepts the risks of injury associated with participation in and transportation to and from the activity. The Participant (or parent/guardian) accepts personal financial responsibility for any injury sustained during the activity or during transportation to and from activity. Further, the Participant (or parent/guardian) promises to indemnify, defend, and hold harmless the activity sponsor and its agents, employees, volunteers, or any other representatives (collectively referred to hereinafter as the "Sponsor") for any injury related directly or indirectly out of the described activity or transportation to and from the activity, whether such injury arises out of the negligence of the Sponsor or othewise. If a dispute over this agreement or any claim for damages arises, the Participant (parent/guardian) agrees to resolve the matter through a mutually acceptable alternative dispute resolution process. If the Participant (or parent/guardian) and the Sponsor cannot agree upon such a process , the dispute will be submitted to a three-member arbitration panel of the American Arbitration Association for final resolution. I understand that I will be required to accompany my child to the Registration Table each day of VBS.