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Compassion Camp: VBS 2024 Waiver 

The Consent/ Waiver below is for VBS with Saint Andrew's Episcopal Church, Seattle. VBS at Saint Andrew's is from August 12th-16th, 2024 and is available for PreK (age four) through outgoing 5th Grade students. By signing below you are indicating that your child/children will be participating in Saint Andrew's VBS and agree to the cost of:

  • Whole Day (9a-3:30p) - $100 for first child, and $75 per additional sibling. 
  • Half Day (9a-12p) - $75 for first child, and $50 per additional sibling.

We don't want anyone to be left out because of cost, so if you are concerned about the cost of VBS, please reach out to Megan McInnis at meganm@saintandrewsseattle.org  and we can schedule a conversation. To pay follow  https://tinyurl.com/saintandrews2023 and place your payment under "Donate to Saint Andrews" with "VBS" in the description box. You can also send a check payable to Saint Andrew's Episcopal Church (111 NE 80th St. Seattle, WA 98115) with VBS in the Memo Line.  


Consent / Waiver / Release:

I hereby give permission to the above named child/children to attend and participate in the activities of Saint Andrew's Episcopal Church, Seattle's, 2024 VBS: "Compassion Camp: What Every Living Thing Needs".



I will take no civil or legal action against the supervising adult(s) for the normal care of the minor in their charge.



I understand that every effort will be made to contact me in the event of any accident or injury to my child. In the event I cannot be reached, I hereby authorize any supervising adult, in whose care this minor has been entrusted, to consent to whatever medical or surgical treatment may be necessary or advisable by the physician or nurse treating such injuries. I understand that I am responsible for the cost of all medical treatment administered to my child.



I/we give permission for the above named child/children to be photographed and or/videotaped during any Saint Andrew's Events and Activities both for VBS 2024, and activities during the academic year of 2024-2025, and the images to be published, reproduced, or distributed by St. Andrew’s Episcopal Church without liability, limitation, or fee.



First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Participant Questions:
Please indicate below whether you would like your child/children to stay for a whole or half day of VBS: *
Half Day Participation (9a -12p)
Whole Day Participation (9a-3:30p)

Please indicate the grade that your student/students last completed in the 2023-2024 academic year: *

Health Concerns (Medical, Allergies or Limitations): *

Please indicate who is authorized to pick up your child/children, and what is their relationship to the child/children?? *
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*

Emergency Contact's Relation to Participant
Insurance

Insurance Carrier*

Insurance Policy Number*
Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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