2017 VBS Registration
Email address *
Student First Name *
Your answer
Student Last Name *
Your answer
Nickname *
Your answer
Age *
Your answer
Grade in School 2017-2018 *
Allergies *
Your answer
Medical Issues or Special Needs
Your answer
Parent Name (first and last)
Your answer
Street Address *
Your answer
City, State, Zip Code *
Your answer
Email *
Your answer
Home Phone Number
Your answer
Cell Phone Number *
Your answer
Emergency Contact (first and last name) *
Your answer
Emergency Phone *
Your answer
T-Shirt Size *
Your answer
Medical Release: I give my permission for the VBS staff to administer basic first aid to my child (named above) in the event of an injury. I understand that the VBS staff will contact emergency services in the event of a significant injury and all expenses for such emergency services will be paid by me.
Photo Release: I hereby grant the above named church permission to copyright and use photographs/videos taken at VBS of the minor designated above in any manner or form for any purpose lawful at any time. I waive any right that I may have to inspect or approve the finished product or written copy, that may be used in conjunction therewith, or the use to which it may be applied. *
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