Vacation Bible School 2025 Signup

Please fill out this form and click submit.

Parent/Legal Guardian Information

Parent/Guardian Name

*

Phone

*

Email

This address will receive a confirmation email

Address

*

Does your family currently have a church that you consider your "Home Church"? If so, where?

Emergency Contact Information (If unable to reach parent/legal guardian)

Emergency Contact Name

Emergency contact's relationship to the child

Emergency Contact's Phone Number

Permission:

I hereby give consent for the above named child(ren) to participate in Vacation Bible School activities. I further agree to hold harmless New Life Church of the Nazarene, Wheeler, Wisconsin, and/or Church Volunteers should injury occur during events sponsored by said church. This permission also includes transportation when provided with qualified vehicles and drivers.

Consent to Participate

*

Please select one option.

Yes No

Photo/Video Permission

We may occasionally photograph or videotape the exciting events and activities that children experience at New Life Church of the Nazarene. Please consider allowing photos or videotape in which your child may appear to be published in NLCN newsletters and/or publications or on our NLCN website.

Consent to photograph

*

Please select all that apply.

Yes No

Child(ren)'s Information

Child 1

Child 1's Name

*

Child 1's Age

*

Child 1's Gender

*

Please select one option.

Boy Girl

Child 1's Birthday

*

Does the child have any allergies, food allergies, chronic illness, medical conditions, or special needs we should be aware of? If yes, please describe.

*

Child 2

Child 2's Name

Child 2's Age

Child 2's Gender

Please select all that apply.

Boy Girl

Child 2's Birthday

Does the child have any allergies, food allergies, chronic illness, medical conditions, or special needs we should be aware of? If yes, please describe.

Child 3

Child 3's Name

Child 3's Age

Child 3's Gender

Please select one option.

Boy Girl

Child 3's Birthday

Does the child have any allergies, food allergies, chronic illness, medical conditions, or special needs we should be aware of? If yes, please describe.

Child 4

Child 4's Name

Child 4's Age

Child 4's Gender

Please select one option.

Boy Girl

Child 4's Birthday

Does the child have any allergies, food allergies, chronic illness, medical conditions, or special needs we should be aware of? If yes, please describe.

Child 5

Child 5's Name

Child 5's Age

Child 5's Gender

Please select one option.

Boy Girl

Child 5's Birthday

Does the child have any allergies, food allergies, chronic illness, medical conditions, or special needs we should be aware of? If yes, please describe.

Child 6

Child 6's Name

Child 6's Age

Child 6's Gender

Please select one option.

Boy Girl

Child 6's Birthday

Does the child have any allergies, food allergies, chronic illness, medical conditions, or special needs we should be aware of? If yes, please describe.

Medical Release and Authorization

(Effective Sept 1, 2024-Aug. 31, 2025)

I hereby give my permission to the physician or dentist selected by New Life Church of the Nazarene, Wheeler, Wisconsin, to hospitalize, to secure proper treatment and/or order an injection, anesthesia or surgery for my child(ren) as
deemed necessary, after every attempt to contact the parent, guardian and/or other emergency contact has failed.

I further agree that I am fully responsible to pay all charges and expenses relating
to such care and treatment. My signature below serves to indicate my willingness for my Health Insurance Company to be billed for any and all medical fees and services should they be needed. I agree that I will pay all charges and expenses not covered by my insurance. My signature below also serves as a medical release for the above mentioned child(ren).

Final Acknowledgement

BY SUBMITTING THIS FORM, I AM CONFIRMING THAT I AM THE LEGAL PARENT/GUARDIAN OF THIS CHILD/CHILDREN, AND FULLY UNDERSTAND AND GIVE MY CONSENT TO ALL OF THE ABOVE. THIS HAS THE SAME LEGAL AUTHORITY AS MY WRITTEN SIGNATURE.

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