Student Name *

First Name

Last Name

Student Name

First Name

Last Name

Student Name

First Name

Last Name

Student Name

First Name

Last Name

Parent's Name *

First Name

Last Name

Phone *

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Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

PERMISSION TO ATTEND *

Permission to Attend: I give permission for my child (named above) to attend the Vacation Bible School listed above. I understand that the information I give for this registration will only be used by the VBS hosting church, and that all registration information will be removed from the hosting site by December 31 of this year.

MEDICAL RELEASE *

Medical Release: I give permission for the VBS staff to administer basic first aid to my child (named above) in the event of an injury. I understand that the VBS staff will contact emergency services in the event of a significant injury and all expenses for such emergency will be paid by me.

PHOTO RELEASE *

Photo Release: I hereby grant the above named chuch permission to copyright and use photographs/videos taken at VBS of 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.

ELECTRONIC SIGNATURE *

I agree and certify that my printed signature is my signature and i agree to conduct this registration electronically.