VBS CHILD REGISTRATION VBS Child Registration VBS Child Registration Child's Name * Child's Name First First Last Last AGE (from 4yrs to 12yrs) * Grade Level * Select a Grade Level PreSchool Rising Kindergartner Rising First Grader Rising Second Grader Rising Third Grader Rising Fourth Grader Rising Fifth Grader Name of Parent or Guardian * Name of Parent or Guardian First First Last Last Cell Phone **This number will be used in case of an emergency * Email * Mailing Address Mailing Address Mailing Address Mailing Address City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Allergies * Yes No Description of Allergy, if applicable Believers Church of Sylvania, Inc. Photograph, Video, and Web Release Form I hereby give permission for images of my child (listed above) and their likeness, with or without name recognition, taken by video, photography, and/or a digital camera to be copyrighted and/or used solely for the purposes of Believers Church of Sylvania, Inc. promotional and/or advertising material, website, and publications, whether print and/or electronic, which includes provision to include statements, such as testimonials, quotes, etc. I waive any rights of ownership or compensation thereto. This release shall remain in effect for each child until that child reaches legal age or this release is rescinded by a parent or audit guardian. I read and accept the above: * YES NO If you are human, leave this field blank. Submit
