EmailMe Form - VBS Registration Form

Participant's Name *
First Last
Age *
If you have more than one child please use this section to list each child with the following info:
(First and Last Name, Age, Any Allergies)
Parent/Guardian Name *
First Last
Email
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Phone *
### - ### - ####
If you have a home church please list here:
How did you hear about our Vacation Bible School? *
Please list adults that have your permission to pickup your child (other than yourself)

Adult 1

Adult 2

Adult 3

For the safety of your child. We will not allow your child to leave with anyone not on this list, until we speak to you using Phone number listed above.
During Bible School, we will be photographing the children. We like to use these photos on our Facebook and website. Would you give permission for your child's photo to be used:
I give permission for my child's picture, and video to be used.
I prefer for my child not to be photographed or videoed.