Student Registration Form
Church of the Saviour's VBS Registration: July 25-29th
Student Name
First Name
Middle Name
Last Name
Grade just competed
blanks
School District
blank
Age
blanks
Gender
Please Select
Male
Female
N/A
Parent/Guardian Name
First Name
Last Name
Alternative Pickup Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
example@example.com
Mobile Number
Phone that will receive text messages
Home Church
In Case of Emergency please contact
First Name
Last Name
In Case of Emergency Phone Number
Please enter a valid phone number.
Photo Release
I hereby grant Church of the Saviour permission to copyright and use photographs/videos taken at VBS activities of my child in any manner or form for any purpose lawful at anytime. I waive any right that I may have to inspect or approve the finished product or written copy, that may be used in conjunction therewith, or the use to which it may be applied.
Other
Medical Release
I give permission for the COS staff to administer basic first aid to my child in the event of an injury. I understand that the COS staff will contact emergency services in the event of a significant injury.
Please state any allergies, health concerns, or special circumstances that we should be aware of.
Submit Application
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