VBS Registration VBS Registration Form 2021 Child's Name Gender Male Female Birthdate Grade Completed Address Address Address Address City City State AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State Zip Zip Parent/Guardian Name Phone Numbers Home Work Cell Email Address Emergency Contact Relationship to child Emergency Contact Phone Who can pick up your child? Name of home church Food Allergies Yes No List Food Allergies Medical concerncs Yes No Explain medical concerns Permission to use images and video I here by grant permission for Church Name to record sounds, images, or video of my child Child's Name while attending this VBS program. I also give permission for Church Name at its sole discretion, to use these sounds, images, or videos in publications (including print, websites, and social media platforms) owned by Church Name in relation to this VBS program. Parent / Guardian Signature Date Δ
