Register me for Keepers of the Kingdom!

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VBS registration

Child's Name *

Gender *

Birthdate

YYYY

Grade Completed *

Address (street, city, state, zip) *

Parent/Guardian *

Phone Nuber *

Emergency Contact *

Relationship to Child *

Emergency Contact Phone *

Who can pick up your child? *

Food Allergies? *

Please List Food Allergies

Medical Concerns? *

Please List Medical Concerns

Permission to use images and video *

I hereby grant permission for Lighthouse Community Christian Church to record sounds, images, or video of my child while attending this VBS program. I also give permission for Lighthouse Community Christian Church at its sole discretion, to use these sounds, images, or videos in publications (including print, websites, and social media platforms) owned by Lighthouse Community Christian Church in relation to this VBS program.

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