Vacation Bible School Registration Form

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Name *

Address *

Home Phone *

E-mail Address *

Age *

Date of Birth *

YYYY

Last school grade completed *

Pre-K to Kindergarten

1st to 3rd Grade

4th to 6th Grade

In case of emergency, contact *

Mother's Name *

Father's Name *

Siblings at VBS *

Allergies or other medical conditions: *

Home Church *

I grant permission to Immanuel for the use of the photograph(s) or electronic media images taken during VBS in any presentation of any and all kind whatsoever. I understand that I may revoke this authorization at any time by notifying the church in writing. The revocation will not affect any actions taken before the receipt of this written notification. Images will be stored in a secure location and only authorized staff will have access to them. They will be kept as long as they are relevant and after that time destroyed or archived. *

Yes

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