Vacation Bible School Registration
Trinity Presbyterian Church - Pensacola, FL
June 19 - 23, 2017
9 AM - 12 PM
Gadgets & Gizmos
Child's Name:
Your answer
Gender:
Last Grade Completed:
Allergies/Health Conditions/Medications:
Your answer
Other Helpful Info (Special needs, restrictions, etc.):
Your answer
Name of Parent(s)/Guardian(s):
Your answer
Address:
Your answer
City:
Your answer
State:
Your answer
Zip:
Your answer
Email Address:
Your answer
Phone 1:
Your answer
Phone 2:
Your answer
Church Affiliation (if any):
Your answer
How did you hear about our VBS program?
Person responsible for picking up the child at 12 PM
Your answer
Phone of person picking child up
Your answer
Students will be grouped by last grade completed. If there is another child that you would like to be grouped with, please list the child's name and last grade completed.
Your answer
WATER DAY is Wednesday! Wear your bathing suit, water shoes and bring a change of clothes and towel.
VBS LIABILITY RELEASE AND PHOTOGRAPHY/VIDEO AUTHORIZATION
In the event of an emergency, I understand that all will be done to contact me or the emergency contact named above. However, if neither can be reached, I give full permission to a representative of Trinity Presbyterian Church to seek medical attention in my absence for the child registered on this form.

I also hereby assume all risk, known or unknown, for the child registered on this form, in connection with their attendance and participation in Vacation Bible School at Trinity Presbyterian Church. I acknowledge that participation in Vacation Bible School at Trinity Presbyterian Church is voluntary and therefore I FULLY RELEASE and discharge Trinity Presbyterian Church, its pastors, employees, directors, and volunteer workers, from any and all liability in connection with any activities carried on at Trinity Presbyterian Church in the Vacation Bible School program.

I further acknowledge that any child registered on this form, as a participant in Vacation Bible School at Trinity Presbyterian Church, may be photographed or captured on video during the Vacation Bible School program and activities. I hereby grant full permission to Trinity Presbyterian Church to use photographs or videos-in print, electronic, online, or other public media-of the child registered on this form and further release Trinity Presbyterian Church from any and all liability connected with the authorized use of words and image of the child registered on this form.

Required
Name of Adult filling out this form.
Your answer
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