Name of Parent/Gaurdian *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

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PARENTAL AUTHORIZATION As the parent or legal guardian of _________________________________________ I certify and affirm that I have been completely and thoroughly informed that as a child attending the St. Paul Lutheran VBS, my child will participate in certain activities which carry with them a degree of risk and danger. I consent to my child’s participation in these activities. I acknowledge and understand that this PARENTAL AUTHORIZATION, CONSENT AND RELEASE has the same force and effect regardless of whether the activities engaged in are free or if a fee is charged. Further, I personally assume, on my child’s behalf, all risk in connection with said activities for any harm, injury or damages that may befall my child as a result of my child’s participation in the activities, whether foreseen or unforeseen, and I still wish to allow my child to proceed with the activities. *

I Agree to the above terms and conditions.