Register for VBS

Family Information

Address

Primary Phone

Alternate Phone

Phone Number

Relationship to Student Father Mother Grandfather Grandmother Great-grandfather Great-grandmother Brother Sister Uncle Aunt Guardian Foster Parent Granduncle Grandaunt Other

Names of other family members authorized to pick up your child

Student Information

Gender

Birth Date

Age Group

Food Allergies

Details

Medical Concerns

Details

Media Consent Release Waiver Media Consent Release Waiver I hereby grant permission for my child to be photographed, videotaped, and/or recorded to promote the church and/or VBS. I understand that the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of use. I waive any right that I may have to inspect or approve the finished product and the advertising or other copy that may be used in connection with herein. If I no longer wish for my child to be included in this agreement, I will contact North Victory Baptist Church to remove him/her from this photo release.

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