VBS 2025 Application

If you would like your child to attend VBS at First Presbyterian Church of Pooler (June 2-6, 2025, from 9am until noon), please complete the Application form below! You will be informed the week of May 15 as to the status of your application. If you have any questions, please email children@firstprespooler.com

Child Information

Child's Name

Grade Your child will be entering in the upcoming school year

Pre-K Kindergarten 1st 2nd 3rd 4th 5th

Date of Birth

Are there any special concerns regarding your child that we should be aware of (allergies, etc.)?

Has your child attended VBS at First Presbyterian Church of Pooler before?

Yes No

Family Information

Does your family belong to or regularly attend a local church?

Yes No

Please provide the name of the local church your family belongs to or regularly attends (if applicable).

How did you hear about VBS at First Presbyterian Church (check all that apply).

At First Presbyterian Church Through the Church Website Through the Church Facebook Page Through a friend Other

Contact Info

Parent/Guardian

This address will receive a confirmation email

Phone

Address

Emergency Contact / Child Pickup Info

Please provide at least one emergency contact, as well as a list of any people other than a parent who may pick up a child from their classroom. We will not release the child to anyone other than a listed person. For the safety of the child, we will ask for ID from anyone we do know personally know. Thank you.

Emergency Contact #1

Emergency Contact #1 Phone:

Emergency Contact #2

Emergency Contact #2 Phone:

Please list any people other than yourself who is authorized to pick up your child from VBS.

Please list anyone whom you do NOT want your child released to (siblings, etc). We will notify parents if anyone on this list attempts to collect child.

Consent and Certification

Please initial each box, and type your name and the date at the bottom to signify you understand and consent to the various consent forms. Thank you.

I, the undersigned, being the parent or legal guardian of the child named above, do hereby consent to the participation of my child in all the scheduled activities of First Presbyterian Church of Pooler. Further, I certify that my child is physically fit and adequately prepared to participate in all recreational and sporting events. If I wish to revoke this consent for any reason, I will promptly notify the Children's Ministry Coordinator in writing.

Medical Treatment Authorization

I understand that I will be notified in the case of a medical emergency. However, in the event that I cannot be reached, I authorize the calling of a doctor and the providing of necessary medical services in the event that my youth is injured or becomes ill. I authorize one or more of the following persons to make emergency medical care decisions on behalf of my child, if required by law or a health care provider: Staff of First Presbyterian Church of Pooler, its representatives, sponsors, or any attending physician. I authorize these persons to act in my place to consent to all necessary and appropriate x-ray examinations, anesthetic, medical or surgical diagnosis or treatment, and hospital care.

I understand that First Presbyterian Church of Pooler will not be responsible for medical expenses incurred solely on the basis of this authorization. I further agree to notify the Children's Ministry Director in writing of any health changes that would restrict my child’s participation in any normal activities. I also understand that the Children's Ministry Coordinator and designated adult chaperones reserve the right to restrict my from child any activity that they do not feel is within the physical capabilities of my child. I, the undersigned parent and/or legal guardian of above mentioned child, do release, acquit, discharge, and covenant to indemnify and hold harmless First Presbyterian Church of Pooler or its representatives from any and all actions, causes of actions, related risks and dangers, including negligence, damages, liabilities arising out of the treatment of any sickness or accident, and any financial responsibility for all medical treatment provided.

I also assume financial responsibility for any damage my child may cause, and for providing transportation home should it become necessary for disciplinary reasons. I also give permission to First Presbyterian Church of Pooler staff, its representatives, and the adult sponsors and chaperones to search my child’s personal belongings, including, but not limited to all luggage, purses, and backpacks, if deemed necessary for the purpose of searching for unlawful or illegal objects.

In consideration of my family being allowed to participate in any part of First Presbyterian Church of Pooler, I acknowledge and agree that participation includes possible exposure to an illness from infectious diseases, including, but not limited to, COVID-19, MRSA and influenza. While particular rules and personal discipline may reduce this risk, the risk of serious illness does exist and I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown. In the event of any such illness, I agree to fully release, indemnify and hold harmless First Presbyterian Church of Pooler, Classical Conversations Pooler Community, and their director, tutors, pastors, employees, staff members, community members, and volunteers from any and all liability, claims and/or litigation that myself, my child(ren), or my family may have which are directly or indirectly related to my child’s participation while at First Presbyterian Church of Pooler.

Photo Release

May we take photographs of your child during this event for them to use in their craft projects, and for our possible use in assembly slideshows, our promotional materials, and our websites?

Yes No

Type Full Name to Sign

Date Signed

VBS 2025 Application

Description

Please Fix the Following