2018 VBS Registration
Phone: 920-848-2177
Email: grace@graceocontofalls.org
Child's Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Grade completed *
Your answer
Food allergies (List if here are any)
Your answer
Parent's / Guardian's Name(s) *
Your answer
Home Address *
Your answer
Home Phone
Your answer
Alternate Phone
Your answer
Email
Your answer
Name of Home Church
Your answer
Emergency Contact
Name
Your answer
Phone
Your answer
Relationship to child
Your answer
Media Release
By clicking "I agree" below, I hereby give Grace Lutheran Church the absolute right and permission to copyright and publish the photographic image of me and my children (listed above) participating in all church-related activities, in all manners, including the use in advertising, publications, trade, websites, social media, and any other lawful purpose. This includes photographic images taken during participation in previous years’ church-related activities.

I waive all rights to inspect and/or approve copy that may be used in conjunction with the photographs and to the uses to which they may be applied.

I also agree that I have read this release and am fully familiar with its contents.

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