Vacation Bible School Registration

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June 12-16
9:0012:00

Child's Name *

Address *

Age *

Grade Exiting *

Pre-k

Kindergarten

First Grade

Second Grade

Third Grade

Fourth Grade

Fifth Grade

Sixth Grade

Gender *

Male

Female

Allergies *

Medical Issues Or Special Needs *

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.

Permission to Attend:I give permission for my child (named above) to attend the Vacation Bible School (VBS) listed above. I understand that the information I give for this registration will only be used by the VBS hosting church, and that all registration information will be removed from the hosting site by December 31, 2019.

Required

Parent/Guardian Name *

Parent/Guardian Address *

Parent/Guardian Phone Number *

Emergency Contact Name *

Emergency Contact Phone Number *

Alternate Pick Up Name *

Alternate Pick Up Phone Number *

Home church (if applicable)

Parent/Guardian (Putting your name in this box acknowledges that all information is correct) *

Submit

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