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Waiver Form\Donations
HERO CENTRAL 2017
Stowe Vacation Bible

Mail To:          Vacation Bible School
c/o Elisabeth Ortiz
1621 Pucker Street #2
Stowe VT 05672


Please List all Children or Volunteers that will be attending the Hero Central SBC:

1.___________________________________________

2.___________________________________________

3.___________________________________________

4.___________________________________________

5.___________________________________________

6.___________________________________________

Waiver:
I understand that I assume all responsibility in case of an accident.  In the event of an emergency involving my child (or children), I request that I be contacted at the number(s) below.   If I am unavailable, you may contact one of the alternate people listed below.  In the event that none of the emergency contact people are available, I give my permission to contact the below named physician (or their representative) to secure proper medical treatment, including, if necessary, emergency treatment and hospitalization.  I accept responsibility for all costs incurred.

Parent/Guardian Name:_______________________________________

Parent/Guardian Signature:____________________________________

Suggested Donation is $40 per child or $70 per family
$15 per Student Volunteer to cover t-shirt cost
(Student Volunteers must be graduating 8th graders and up)

( Make checks payable to: Stowe Community Church )

Donation:

Name: ____________________________________________________________ 
           
Number of Participants:________________

I have Enclosed my check (#______) for $__________.

I have included an additional (tax deductible) donation of $______.