By clicking 'Submit' I understand that Mifflinburg Church of the Nazarene assumes no responsibility for injuries or illnesses which my child may
sustain as a result of participation in Vacation Bible School 2014. I acknowledge that I assume the risk for any and all
injury and illness which may result from participation in VBS. In consideration of the privilege of participating in
Vacation Bible School, I hereby voluntarily release and discharge Mifflinburg Church of the Nazarene and its agents,
servants, volunteers, and employees from any and all claims for injury, illness, death, loss, or damage which may be
suffered as a result of participation in VBS. A parent/responsible party must discuss with the VBS director any special
conditions or circumstance involving their child prior to participation. I hereby give permission to the medical personnel
selected by Mifflinburg Church of the Nazarene staff to order x-rays, routine tests, treatment, to release any records necessary for insurance purposes
and to provide or arrange necessary related transportation for me/my child in the event of a medical emergency. I
understand that no accident/medical insurance is provided with this activity. I also hereby grant Mifflinburg Church of the Nazarene permission to photograph, film, or record my child for the purpose internal VBS use or external VBS promotion.