Register for VBS

Family Information

Address

Primary Phone

Alternate Phone

Relationship to Student Father Mother Grandfather Grandmother Great-grandfather Great-grandmother Brother Sister Uncle Aunt Guardian Foster Parent Granduncle Grandaunt Other

Phone Number

Student Information

Gender

Birth Date

Age Group

Food Allergies

Details

Medical Concerns

Details

Photo Release Yes No I agree and consent to the use of any pictures or video of the above child during the program to use for training and/or publicity purposes. In addition to being displayed inside the church, the pictures may appear in training slides/videos, our website, our Facebook page, brochures and the local newspaper. Names of the children will never be used with their pictures.

Waiver of Responsibility Yes No I give the child listed above permission to participate in this program. The leaders will not be held responsible for injury, etc.

I have more students to register