VBS 2026 Student Registration

REGISTRATION
Child First Name

Child Last Name

Street Address or Box #

City or Town

Province

Postal Code

Email Address

Birth Date of Child

Sex of Child
FemaleMale

Select the grade the child is entering in the fall of 2026
KindergartenGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6

Friend Request. Please list any other children your child may want to be placed in a class with.
Although we can’t guarantee it, we will do our best to accommodate everyone’s requests.
Please separate multiple names with a comma.

Church you attend regularly (leave blank if none)

Primary Contact Name

Primary Contact Phone #

Secondary Contact Name

Secondary Contact Phone #

Medical Needs / Allergies / Special Needs

Do you give permission for your child to leave on their own after VBS is done for the day?
YesNo

If you answered ‘YES’ to the previous question, you can skip the following question and proceed to the next question.
Who do you authorize to pick up your child in addition to the Primary & Secondary stated above?
Your child will not be released to unnamed persons not listed on this form.
Please list the full legal name(s). Please separate multiple names with a comma.

CONSENT & WAIVER
For participation in VBS activities including: Sports, Slip and Slide & Bouncy Castle Activities
Parent or Guardian Name

Parent or Guardian Phone #

I, the undersigned parent or legal guardian of the above-named child, give permission for my child to
participate in the slip and slide and bouncy castle activities during the Osler Mission Chapel VBS program.
I understand that these activities involve inherent risks, including but not limited to: slipping, falling,
collisions with other participants, and other potential injuries. I acknowledge that while reasonable
precautions will be taken by the organizers, there is still a possibility of injury.

By signing below, I confirm that:
1) My child is in good health and physically able to participate in all activities associated with VBS.

2) I release and hold harmless Osler Mission Chapel, its staff, volunteers, and property owners from any liability,
claims or legal action arising from my child’s participation in this event.

3) I will support VBS staff by encouraging my child to follow all safety rules and instructions.

SIGNATURE
I certify that I am the legal parent or guardian of the child named above and that I have read and
understood this waiver and consent form. I agree to its terms voluntarily.
Please sign in the box below.