VBS

Participant Registration

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VBS

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.)

Personal Information

*Participant's First Name:
*Participant's Last Name:
*Parent/Guardian Name:
*Address:
*City:
*State:
*Zip:
Primary Phone: (555-555-5555)
Work Phone: (555-555-5555)
Cell Phone: (555-555-5555)
Email:
*Birthday: (MM/DD/YYYY)
*Last Grade Completed:
Allergies, Medical, & Special Needs: (Leave Blank if None)
*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:
Are you a member of this church?	Yes
Guest of:
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
T-Shirt Size:
Comments:
Gender: