2026 VBS Illuminate- Student Registration

Todays Date

Student Information

Name

Age

Grade based on 25-26 School year.

Kinder 1st 2nd 3rd 4th 5th

Student Medical Information

Please list any allergies to drugs, foods, plants, insects, etc:

Please list any additional information relevant to participating in CP group activities (dietary needs; surgeries or serious injuries; chronic or recurring illness; medical conditions such as epilepsy or diabetes; psychiatric counseling or indications, etc.), or Special Needs (Autism, Down Syndrome, etc.)

Parent Information

Name

Phone

This address will receive a confirmation email

Emergency Contact

Please let us know who we can contact if your Parent cannot be reached.

Name

Phone

How is this person related to the Student?

Shirts

Shirt Size

Small Medium Large XL 2XL

Waivers

Description of Permission

I give permission for my child to attend Changing Pointe Church’s 2026 VBS. I understand that this event will take place on-site at Changing Pointe Church, under the care and supervision of Changing Pointe Church staff and approved volunteers.

I agree I disagree

Medical Release

I hereby authorize Changing Pointe Church staff, teachers, drivers, hospitals, licensed medical or dental providers, and their authorized agents or employees to access the information contained in this form. I give permission for them to provide all necessary medical or dental care, routine tests, treatment, and transportation deemed advisable for the health and safety of my child. This authorization includes the authority to consent to any x-ray examinations, anesthesia, medical or dental procedures or treatments, and hospital care that is recommended and rendered by a physician or surgeon licensed under the Medical Practice Act, or a dentist licensed under the Dental Practice Act.

I agree I disagree

Waiver of Liability

I fully understand, and will not hold Changing Pointe Church, any of its agents, assigns, employees, or volunteers liable for any accidents, injuries, or any other unforeseen harms incurred at any time while participating in this activity, except in the case of gross negligence.

I agree I disagree

Activities Release

I further give permission for my child to participate in all supervised activities.

I agree I disagree

Media Release

I hereby consent to the participation in interviews, the use of quotes, and the taking of photographs, movies or video tapes of the Student named above by CP Staff. I also grant CP Staff the right to edit, use, and reuse said products for non- profit purposes including use in print, on the internet, and all other forms of media. I also hereby release Changing Pointe Church and its agents and employees from all claims, demands, and liabilities whatsoever in connection with the above.

I agree I disagree

Parent Signature

By Typing my name I give my student permission to participate in all the 2026 CP Illuminate VBS

2026 VBS Illuminate- Student Registration

Description

Please Fix the Following