Collide 2025-2026

Welcome to Valley Brook Students! Please take a moment to register your student/students. Please fill out the following information as it pertains to your student. Thank you!

Your name *

Email address *

What is your student's name? *

Phone number

Birthdate

Grade

Gender

School

Address

Household members

Additional Information:

Please list any behavioral diagnoses, learning disabilities, and/or special needs that your child has so we may better serve him/her.

Sign-out preference at end of activity (check one): *

My child may sign themselves out

I will sign my child out

Please list any allergies or medical concerns.

Besides the Parent/Guardian information listed below, is there anyone else that you authorize to sign out / pick up your student? If yes, please list their first & last name/relationship and cell phone # here:

Photograph Release Form: Do you give permission for your child/children to be photographed and his/her image to be used in electronic/printed publications of VBCC including anonymous photos on social media and the church’s website? *

Yes, I give permission.

No, I do NOT give permission.

General Release Authorization: *

I give permission for my child to attend and participate in the Collide program at Valley Brook Community Church during the 25/26 school year. I understand that this participation will involve individual and group activities and there is a possible risk of injury or illness. I wholly release Valley Brook Community Church from any responsibility or liability and waive any claims or causes of action against Valley Brook Community Church or it’s agents/volunteers, except in a situation of gross negligence on the part of Valley Brook Community Church or it’s agents/volunteers.

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