VBS Registration 2016

Barnyard Roundup VBS Registration 2016

* Indicates required field

Student's Name *

First

Last

Age *

Gender *

Male Female

Grade entering this Fall *

T-Shirt Size *

Home Church (if applicable) *

Pastor's Name (if applicable) *

Allergies *

Medical Issues or Special Needs *

Parent Name(s) *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Home Phone Number *

Cell Phone Number *

Email *

Emergency Contact *

First

Last

Emergency Phone Number *

Alternate Pickup Name *

First

Last

Alternate Pickup Phone Number *

How did you hear about this VBS? *

Medical Release *

I give my 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 services will be paid by me.

General Information or Other Comments *

Photo Release *

I hereby grant the above named church permission to copyright and use photographs/videos taken at VBS 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.

By clicking "Submit" below, I give permission for my child (named above) to attend the Vacation Bible School (VBS) 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.

Submit