Shipwrecked VBS 2019 Registration
Full Name
Your answer
Child's Gender
Date of Birth
MM
/
DD
/
YYYY
Last School Grade Completed
Name of Parent(s)
Your answer
Street Address
Your answer
City
Your answer
State
Your answer
Zip
Your answer
Home Telephone
Your answer
Parent/Caregiver Cell no.
Your answer
Home email address
Your answer
Home church
Your answer
Allergies or other medical conditions
Your answer
In Case of Emergency, contact:
Your answer
Phone:
Your answer
Relationship to Child
Your answer
Media Release: This consent form will authorize Argentine Mennonite Church to use and print photographs and any other form of media material for educational, informational and promotional purposes. Images may be used, but is not limited to, Argentine Mennonite Church publications and newsletters, newspaper articles, advertising material, web listings, websites, etc. This Media Release Form will be kept on file by Argentine Mennonite Church as reference for individual approval.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service