VBS CHILD REGISTRATION VBS Child Registration (July 11, 12, 13) VBS Child Registration (July 11, 12, 13) Child's Name * Child's Name First First Last Last AGE (from 4yrs to 12yrs) * Grade Level * Select a Grade LevelPreSchoolRising KindergartnerRising First GraderRising Second GraderRising Third GraderRising Fourth GraderRising 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 AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal T-Shirt Size * Youth SmallYouth MediumYouth LargeOther T-Shirt Size 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 This release shall remain in effect for each child until that child reaches legal age or this release is rescinded by a parent or audit guardian.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
