June 6-10, 6:00-8:30 p.m.
2200 Sheridan Rd., Noblesville,  IN  46062

Sign up your kids for our Life Church Vacation Bible School
at our Noblesville Campus!  
FREE and open to the community, this event is one way Life Church strives to let all kids have the chance to hear the good news of Jesus and share in the joy and friendships of a fun-filled and safe atmosphere.  
This event is limited to ages 4 years - 5th grade (Must be 4 by June 7)  
(Grade applies to the grade the child will be in for the 2022-23 school year) 

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* 1. Child (First Name only)

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* 2. Child (Last Name only)

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* 3. M/F?

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* 4. Age (must be age 4 before the first day of VBS)

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* 5. Birthday (00/00/0000)

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* 6. Grade for 2022-23 school year

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* 7. Is there a friend that you want to be with in a group?
(placement not guaranteed)

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* 8. Child's Medical Information (must complete- use N/A if not applicable to your child)

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* 9. Family Information:

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* 10. Do you have a church you currently attend?

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* 11. Which church do you currently attend, if any?

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* 12. MEDICAL CONSENT AND RELEASE:

I, the undersigned, have legal custody of the child named above, a minor, and have given my consent for my child to attend events being organized by Life Church Assembly of God, Inc. (“Church”). The Church includes its Pastors, employees, agents, and volunteer workers. I understand and consent that my child may be taught Biblical principles.

*   Medical Consent: If my child experiences a medical situation, and I or my emergency contact cannot be reached, I give my permission to seek whatever medical attention is deemed necessary by the Church, and transport my child by ambulance or private vehicle to the nearest medical facility. In the event that my child is injured and requires medical services, I consent to any medical treatment as deemed necessary by a licensed physician. I also acknowledge that I will be ultimately responsible for the cost of any medical services should the costs not be reimbursed by any health insurance provider. I release the Church from any and all medical services and costs.

*  Release: I understand that there are inherent risks involved in any ministry or activity, and I hereby release the Church from any and all liability, loss, or damage to person or property that may occur during the course of my child’s involvement. In the event treatment is required from a physician and/or hospital personnel designated by the Church, I agree to hold the Church free and harmless of any and all liability, claims, demands, or suits for damages arising from the giving of such consent.

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* 13. Shirts are available for purchase for $10.  If you wish to purchase one, please indicate size below.

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* 14. CD's of the worship videos are available for purchase for $10 each.  If you are interested in this option, please indicate how many below.
(payment options are at the end of this form)

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* 15. If you are purchasing a t-shirt or CD, please indicate payment method below.   To make an online payment, please click here.

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* 16. Questions?  Comment below or email Pastor Marilyn Mahoney:  marilyn@lifechurchin.com

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