VBS Child Registration Form

A t-shirt is not guaranteed for your student if they are registered after June 2nd

Student's Name

First Name

Last Name

Parent/Family/Guardian Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Student's Date of Birth

YYYY

Student's Age

Student Shirt Size

Last school grade completed

Home Church (if any)

Friends of your child at this church

Special Needs/Allergies/Medical Information/Other:

Emergency Contacts

Emergency Contact #1

First Name

Last Name

Emergency Contact #1 Phone Number

(###)

###

####

Emergency Contact #2

First Name

Last Name

Emergency Contact #2 Phone Number

(###)

###

####

Name(s) of person(s) who may pick up this child from VBS

Photo Release

Lifehouse Fellowship Church/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.

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VBS Child Registration Form

A t-shirt is not guaranteed for your student if they are registered after June 2nd

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