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Summer Jam VBS Registration

Please fill out the form below and click the "Send mail" button at the bottom of the page.

* Required Fields

*Child(s) last Name:
*Child(s) first Name:
*Street or PO Box:
*City:
*Zip code:
*Phone number:
*Grade entering:
Church:
*Parent(s):
*E-mail address:
Allergies/medication:
Questions or comments:
* LIABILITY RELEASE I (We) acknowledge that my childâ€™s participation in the Cedar Creek Church youth program is voluntary and may require involvement in activities that require traveling or physical exertion. Such activities may include, but are not limited to: outings, athletic games, local excursions, and meetings. Therefore I (we) waive, release, and discharge from any and all claims or liabilities for death or personal injury damages of any kind, which arise out of or relate to my childâ€™s participation in Cedar Creekâ€™s Youth activities, the following person, or entities: Cedar Creek Church, itâ€™s Senior Pastor, youth pastor and any volunteers and representatives of any of the above except in the case of gross negligence on the part of Cedar Creek, Cedar Creek staff or Cedar Creek volunteers. Please check box. :
I (we) give my permission for the VBS staff to administer basic first aid to my child (named above) in the event of an injury. I understand that the VBS staff will contact emergency services in the event of a significant injury and all expenses for such emergency services will be paid by me. Please check box if approve.:
I (we) hereby grant the above named church permission to copyright and use photographs/videos taken at VBS of the minor designated above in any manner or form for any purpose lawful at any time. I waive any right that I may have to inspect or approve the finished product or written copy, that may be used in conjunction therewith, or the use to which it may be applied. Please check box if approve.:
*Authentication:
*5 + 6 =	Enter the correct answer to the math question.
Please click the Send button only once.

Sunday
Sunday morning service	10:00 AM

Cedar Creek Church
30 East Main Street
PO Box 224
Hayfield, MN 55940
507-477-2255
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