VBS Registration

Please fill out this form for EACH child who will be attending. We can't wait to see how much fun your child has with us at VBS! See you there!

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Child Name

First

Last

Child Age

Child Gender

Days Child will be attending

Parent/Family/Guardian Name

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Layout

Contact Number

Home Church (if any)

Special Needs/Allergies/Medical Information/Other

Additional Person authorized to pick up child

First

Last

Emergency Contact

First

Last

Phone

Photo Release

Northeast Church of Christ/VBS has my permission to use my child’s photograph publicly in VBS materials. I understand
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 such use.

Name of Person Submitting Form

First

Last

Matthew 19:14