Press Play! and XLR8 VBS 2021

Participant Registration

If you or your child would like to participate in this event as a Participant, please complete the following form.

(If you are under 18, please have your parent or guardian complete the form.)

If you have previously registered with us for a prior event, you can search for your stored information instead of filling out the form below.

Personal Information

*Participant's First Name:
*Participant's Last Name:
*Birthday: (MM/DD/YYYY)
*Gender:
*Last Grade Completed:
*Parent/Guardian Name:
*Email:
*Cell Phone: (555-555-5555)
Home Phone: (555-555-5555)
Work Phone: (555-555-5555)
*Address:
*City:
*State:
*Zip:
*Emergency Contact Name (1):
*Emergency Contact Phone (1): (555-555-5555)
Emergency Contact Name (2):
Emergency Contact Phone (2): (555-555-5555)
*Authorized Pickup #1:
Authorized Pickup #2:
Authorized Pickup #3:
Authorized Pickup #4:
Allergies, Medical, & Special Needs: (Leave Blank if None)
Are you a member of this church?	Yes
Do you attend Church?	Yes
If so, where?
May we have permission to photograph your child?	Yes
May we have permission to use your child's photograph in church publications?	Yes
Comments:
*Preferred Name for Name Tag: