Vacation Bible School

Contact Information

Medical Information

Permission To Photograph

I also understand that as a participant, the child/minor/participant or adult listed above, may be photographed or videotaped during the event and these photos/videos may be used in Living Waters Church's printed material and the web site of Living Waters Church, Dutton, VA.

Liability Release

I hereby waive any and all claims, demands, and causes of action, of every kind and character for personal injury or property damage related to participation in activities of Living Waters Church. I also understand that if I am unable to be contacted in case of a medical emergency, hereby authorize any Pastor, Staff, Teacher, Volunteer, Church Member and/or adult sponsor who may be supervising or directing any activity sponsored by Living Waters Church, Dutton, VA emergency medical treatment for the minor listed above while this minor is participating in any trip, excursion or activity sponsored by Living Waters Church, Dutton, VA. I understand that the sponsors will attempt to contact me at the earliest appropriate time concerning such treatment.