EmailMe Form - VBS Registration 2019

Student's Name *

First Last

Gender *

Male

Female

Student's Age *

Grade going into Fall 2019 *

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Parent or Guardian's Name *

First Last

Parent's Cell Number *

### - ### - ####

Parent's Email *

Emergency Contact *

First Last

Emergency Contact's Phone *

### - ### - ####

Allergies or Special Considerations

I give Fort Saskatchewan Alliance Church permission to use photos taken during the week of VBS for promotional materials. *

Yes

No

I authorize Fort Saskatchewan Alliance Church and it's staff and volunteers to obtain medical assistance in the case of an emergency. *

Yes

No

By checking this box you affirm that all information given to Fort Saskatchewan Alliance Church is true. *

Yes