Parent/Guardian:

Address:

City:

State:

Email:

Cell Number:

Child 1:

Age:

T-Shirt Size:

Who is allowed to pick up your child if other than you?

Allergies or other medical conditions we to know about:

Emergency Contact (name and number):

Photo Release:

First Name:

Last Name:

Children’s Name(s)

Child 2:

Child 3:

Child 4:

Child 5:

By checking the box above, I give permission for my child to be photographed during Vacation Bible School.  The photos may be used for craft projects and/or to promote children’s ministry.  The photos will not be used for outside advertising or promotion.

Zip:

Grade: