| PLEASE NOTE: Admission of this form by email constitutes permission for your child to participate and authorizes Calvary Church to use photos/videos which may include your child in publications, videos and/or online. All use of photos and videos will be for appropriate and God - honoring purposes. ALSO: If you want to change any info from last year (ie: authorized pick up person, cell phone number OR email, please fill out a new registration form. |
| *Participant's First Name: |
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| *Participant's Last Name: |
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| *Last Grade Completed: |
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| *Birthday: |
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| *Gender: |
Male Female (circle one) |
| *Parent/Guardian Name: |
__________________________________ |
| *Address: |
__________________________________ |
| *City: |
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| *State: |
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| *Zip: |
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| *Home Phone: |
(______)______-________ |
| Work Phone: |
(______)______-________ |
| *Cell Phone: |
(______)______-________ |
| *Email: |
__________________________________ |
| Allergies, Medical, & Special Needs: |
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| *Emergency Contact Name (1): |
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| *Emergency Contact Phone (1): |
(______)______-________ |
| *Emergency Contact Name (2): |
__________________________________ |
| *Emergency Contact Phone (2): |
(______)______-________ |
| *Authorized Pickup #1: |
__________________________________ |
| Authorized Pickup #2: |
__________________________________ |
| How did you hear about our VBS?: |
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| T-Shirt Size: |
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| Comments: |
|
| *Preferred Name for Name Tag: |
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