Registration for VBS Zoomerang 2022
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Event Timing: July 11-15, 6:00 PM - 8:00 PM Event Location: Grace Community Church 155 Pump Branch Road, Waterford Works, NJ 08089  Contact us at our website - place4grace.org;  e-mail: place4gracenj@gmail.com.                                                                       STUDENT NAME:
AGE:
GENDER:
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GRADE ENTERING:
ALLERGIES:
MEDICAL ISSUES OR SPECIAL NEEDS:
PARENT NAME:
ADDRESS:
E-MAIL ADDRESS:
PREFERRED PHONE NUMBER:
EMERGENCY PHONE NUMBER:
HOME CHURCH (OPTIONAL):
Medical Release: I give my permission for the VBS staff to administer basic first aid to my child (name above) in the event of an injury. I understand that the 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 copy right and use photographs/videos taken 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 VBS-Zoomerang listed above. PARENTS NAME AND DATE:
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