Living Word Harvest Of Dallas - Media

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Sep 16, 2025

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Yee-Haw "VBS"
"Boots on the Ground for Jesus"
CONSENT / WAIVER
PARENTAL CONSENT FORM

I authorize my child to participate in all activities of Living Word Harvest of Dallas’ “Yes-Haw" (VBS) on July 24th- July 26th, Thursday-Saturday 2025..

I hereby waive, release, and hold harmless Living Word Harvest of Dallas, the “VBS” Director, all adult and youth supervising sponsors from all liability, damages, injuries, claims, demands and causes of action. I and / or family member may have arising out of “VBS”. I understand that many of the activities during “VBS” come with inherent risks. By allowing my child to participate in these activitiesI understand, accept and assume the risks.

I / We, have been fully explained that the church does not warrant, or represent that its services and premises are of particular standard or quality or grade, in that the children may be unpredictable and their use of the premises, or items may result in accident or injury.
I represent that my child / minor is physically able, without accommodation to participate in the “VBS” activities. I represent that my child / minor has obtained the required immunizations. Should my child / minor require emergency medical treatment as a result of accident or illness during “VBS”. I consult to such treatment and acknowledge that Living Word Harvest of Dallas does not provide health and accident insurance for “VBS” participants, and I agree to be financially responsible for any medical treatment. I will list below medical conditions my child / minor has about which emergency medical personnel should be informed. In case of an emergency please contact me at the emergency number listed below.

Parent's First Name

Parent's Last Name

Child's First Name

Child's Last Name

Gender

Phone Number

Emergency Phone Number

Allergies

Child's Tetanus Shot current?

Yes

No

A list of conditions emergency medical personnel should be aware of:

Text Area

Medical Coverage with:

Text Input

Policy Holder:

Text Input

Policy / Group Number:

Text Input

Number Input

Signature

Participant's First Name

Participant's Last Name

Parent's First Name

Parent's Last Name

Gender

Birthdate

Allergies

Grade

Phone Number

Emergency Contact First Name

Emergency ContactLast Name

Emergency Contact

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

How often would you like to volunteer?

Once a month

Twice a month

Three times a month

Other

Are you a member of this church?

Yes

No

In Process

Which serving opportunities are you interested in?

Preschool Ministry

Kids Ministry

Students Ministry

Welcome Team

Music Team

Administration

Media Team

Graphic Design

Communications

Events

Other

First Name

Last Name

Email

Phone Number

Anything else you would like to share?

Living Word Harvest exist to bring glory to God by making
disciples through kingdom-centered worship building in the
community, kingdom-centered service and kingdom-centered
multiplication.
REACHING TEACHING MENDING SENDING

2429 Randolph St.
Dallas, TX 75241

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