VBS Single Registration

FAMILY INFORMATION

STUDENT INFORMATION

* Indicates required field

Parent/Guardian Name *

First

Last

Child - Name *

First

Last

Parent/Guardian Email *

Child's Gender *

Male Female

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

This phone is a: *

Emergency Contact *

First

Last

Emergency Contact Relationship to Child *

Emergency Contact Phone Number *

Permission to use images and video

I hereby grant permission for Greendale Baptist Church to record sounds, images, or video of my child(ren) while attending Vacation Bible School. I also give permission for Greendale Baptist Church at its sole discretion, to use these sounds, images, or videos in publications (including print, websites, and social media platforms) owned by Greendale Baptist Church.

Photo Release Name *

First

Last

Photo Release Date *

*By typing my name and date above, I agree to use this as my signature for this permission form.

Child's Birthdate *

Any Food Allergy (please list)? *

Any Medical Concerns? *

REGISTER FOR MYSTERY ISLAND​VBS 2021

FAMILY INFORMATION

STUDENT INFORMATION

Permission to use images and video

REGISTER FOR MYSTERY ISLAND
VBS 2021