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Student Full Name (required)

Age Group (required)

Group 1(4-6 years)Group 2(7-9 years)Group 3(10-13 years)

Gender      T-Shirt Size         Allergies(If Any)

—Please choose an option—MaleFemale   —Please choose an option—SmallMediumLarge      

Parents Full Names(required)                             Emergency Phone(required)

Alternate Emergency Phone                                 Email (required)

Medical conditions or Other Needs(Need Ride?/Days Attending etc)(If Any)

Terms and conditions:

Note: Although we set ourselves to work hard and give the safest environment for VBS we are required to take this release

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.

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 my 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.

Parental Consent: By checking this box, I agree to all the terms and conditions mentioned above.