Hickory Church of Christ Vacation Bible School  For 2 Years - Teens and Adults
Sun. - Tues., Aug. 6-8, 2023: 5:30pm - 8pm - Light Meal at 5:30; VBS Starts at 6pm
1218 Fairgrove Church Rd., Hickory, NC - Check-in Around Back in Fellowship Hall for Meal
Contact us at 828-464-4983 or office@hickorychurch.org

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Child #1 Name *
Child #1 Grade (2022-23) or Age if < 5 *
Child #1 Birthday *
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Child #1 Gender *
Child #2 Name
Child #2 Grade (2022-23) or Age if < 5
Child #2 Birthday
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Child #2 Gender
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Child #3 Name
Child #3 Grade (2022-23) or Age if < 5
Child #3 Birthday
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Child #3 Gender
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Please list your church home, if you have one or write N/A. *
How many adults will attend the Adult VBS class?
How many adults & kids will attend for meals? *
Parent/Guardian Name *
Parent/Guardian Number *
Emergency Contact - Name *
Emergency Contact - Phone *
Allergies - Include Child's Name and Allergies *
Parents' Email Address *
Parents' Address - Street Address, City, State, Zip *
How did you hear about our VBS? Please Be As Specific As Possible. *
As the Parent/Legal Guardian of (Child/Children listed above), I authorize Hickory Church of Christ, into whose care the minor(s) has/have been entrusted, to consent to medical or dental treatment. It is understood that this authorization is given in advance of any specific diagnosis or treatment being required and is given to provide authority and power to render care which the aforementioned physician, in his or her best judgment may deem advisable. Please type your name (as signature). *
The undersigned hereby releases, waives, discharges and covenants not to sue the Hickory Church of Christ, its directors, officers, employees, and members (herein after referred to as releases) from all liability to the undersigned, his personal representatives, assigns, heirs, and next of kin for any loss or damage, and may claim or demand therefore on account of injury to the person or property or resulting in death of the undersigned, whether caused by negligence of the releases or otherwise while the undersigned is in, upon, or about the premises or any facilities or equipment therein; the undersigned allows for images or videos of guests or the guest's family to be used by Hickory Church of Christ in any legal manner without payment to the guest.                                                        The undersigned hereby agrees to indemnify and save and hold harmless the releases from any loss, liability, damage or cost that may incur due to the presence of the undersigned in, upon, or about the Hickory Church of Christ premises or in any way observing or using any facilities or equipment of the Hickory Church of Christ whether caused by negligence of the releases or otherwise; and                                                                    The undersigned hereby assumes full responsibility for and risk of bodily injury, death, or property damage due to the negligence of the releases or otherwise while in, about or upon the premises of the Hickory Church of Christ and/or while using the premises or any facilities or equipment hereon. You will have the opportunity to sign the form at the Event. PLEASE TYPE YOUR NAME HERE, AS YOUR SIGNATURE FOR THIS ONLINE REGISTRATION FORM. *
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