Resistration Deadline: June 10, 2019
(Rockland Family priority registration April 14-30
Registration for all others begins May 1)
VBS Communication is done through email. You will not be added to our regular Rockland email unless requested.
Sponsored by: Kids' Ministry Team of Rockland Community Church
Scholarships available, please contact Lori Fullmer- LFullmer@Rockland.Church
Tanzania NICU Fund- We are excited to partner with Arusha Lutheran Medical Cewnter in northern Tanzania, a leading resource for critically ill newborn babies. The funds we raise during VBS will go to help support their Newborn Intensive Care Unity, and the families they serve. The average cost per child is $80/day - a fraction of the cost in the U.S. Without support of the NICU Fund, many infants would not have access to the care they need. We rejoice at the opportunity we have to help these infants and their families!
Rockland Community Church
Authorization to Participate, Medical Treatment Authorization and Release from Liability
1. Authorization to Participate
I give ______________________________ permission to participate in all activities with Rockland Community Church. This authorization and release is valid for one year from date below. I hereby personally assume all risks in connection with my child’s attendance and participation in the events at Rockland Community Church.
, links, and images here.
2. Pre-Authorization for Medical Treatment
I (we), the parents/guardians of said named student(s), do hereby authorize Rockland Community Church to serve as agents for the undersigned, to consent to any x-ray examination, anesthetist, medical or surgical diagnosis or treatment and hospital care which is deemed advisable by the attending physician licensed under the provision of the Medical Practice Act on the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at office of said physician or said hospital. I further authorize Rockland Community Church staff or agents to render first-aid and to administer medication as prescribed and received from parent/guardian.
3. Acknowledgement of Financial Responsibility
In the event that my child is injured on church property or during church activities, I acknowledge that I shall be personally liable for, and agree to pay, all costs and associated expenses incurred in connection with medical and/or dental services rendered to my child in response to said injury.
4. Limitations on Insurance Coverage
I understand that my personal insurance coverage will be the primary coverage. No additional coverage is provided by Rockland Community Church. I agree to the release of any records necessary for treatment, referral, billing or insurance purposes.
5. Release and Hold Harmless Agreement
I agree to release and hold harmless Rockland Community Church, it trustees, employees, agents, and representatives for any injury, harm or other damage by any occurrence in connection with my child’s participation in church activities in any form or fashion.
6. Use of Child’s Photograph
I agree and consent that my child’s photograph may be used for promotional purposes or publicity material by Rockland Community Church.
Have Question? Contact Lori Fullmer, Kid's & Family Ministry Director. LFullmer@Rockland.Chruch or 303.526.0668 x 206