Vacation Bible School 2010 June 14-18, 2010 9:00am-12:30pm
REGISTRATION FORM: Please list each child's current grade level (2010-2011) and date of birth. NAME 1ST. CHILD: DATE OF BIRTH: GRADE: NAME 2ND. CHILD: DATE OF BIRTH: GRADE: NAME 3RD CHILD: DATE OF BIRTH: GRADE:
NAME 4TH CHILD: DATE OF BIRTH: GRADE:
PARENT # 1
NAME:
ADDRESS: CITY: STATE: ZIP:
HOME PHONE: WORK PHONE: CELL: EMAIL:
PARENT #2
3RD PARTY CONTACT: CELL PHONE:
Please list the names of any individuals, in addition to parents, who are able to pick up your child/children from VBS.
Does your family currently have a home church: yes no
Does your child have any allergies? Child #1 Child #2 Child #3 Child #4
I give my child permission to have Tylenol or Benedryl if needed. yes no
I understand that First United Methodist produces promotional materials about this event. I understand that my child may be included in video and/or photography taken at this event. I hereby grant First United Methodist the rights to photograph and/or videotape my child and further utilize participant's name, face likeness, voice and appearance as part of the event and in advertising and promoting the event, without reservation or limitation. In granting this license, I understand that First United Methodist is under no obligation to exercise any of its rights, licenses or privileges here granted by participation.
yes, you have permission
no, do not use my child