2026 Brighton Heights Community Vacation Bible School

2026 Brighton Heights Community Vacation Bible School
June 15th-19th 5:00-7:45pm Located at All Saints Episcopal Church, 3577 McClure Ave, Pittsburgh, PA 15212

Questions? Please email brightonheightscommunityvbs@gmail.com
STUDENT REGISTRATION FORM
CHILDS NAME
Childs preferred name to be called
Childs Age
Childs Birth Date

MonthDayYear
Date
Childs Grade in the fall
Address
ParentGuardian Names
Home Phone
Format: (000) 000-0000.
Mobile
Format: (000) 000-0000.
Other
Email
example@example.com
Preferred Contact Method
EMERGENCY INFORMATION
Emergency Contact 1
Phone
Format: (000) 000-0000.
Emergency Contact 2
Phone
Format: (000) 000-0000.
Doctor
Phone
Format: (000) 000-0000.
Allergies or Special Needs
DISMISSAL
Who may pick up your child at the end of VBS each day?
Name
Relationship
Name
Relationship
ParentGuardian Signature
Date

MonthDayYear
Date
I, the parent or guardian
, hereby certify that I am the parent, or legal guardian, of:
The following minor child
Date of Birth

MonthDayYear
Date
I hereby grant Brighton Heights Community Vacation Bible School permission to use my child's likeness in a photograph, video, or other digital media ("photo") in any and all of its publications, including web-based publications, without payment or other consideration.

Iunderstand and agree that all photos will become the property of Brighton Heights Community Vacation Bible School.

I hereby irrevocably authorize Brighton Heights Community Vacation Bible School to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my child likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photo. I hereby hold harmless, release, and forever discharge the Brighton Heights Community Vacation Bible School from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization. I have read and understand this release and agree to be bound by its terms. I am over 18 year of age and am/are authorized and competent to sign this release. I understand that this release will remain in effect indefinitely unless revoked by us in writing.
Signature of Parent or Legal Guardian
Date

MonthDayYear
Date
Should be Empty:

2026 Brighton Heights Community Vacation Bible School

STUDENT REGISTRATION FORM

EMERGENCY INFORMATION

DISMISSAL