MAGNIFIED! VACATION BIBLE SCHOOL AUG 11th -15th 9am -12pm
For Kids in K - 5th Grades
REGISTRATION FORM
Child's Name
*
First and Last Name
Birthdate
Please list additional children and their birthdates
Please remember VBS is for kids in K-5th grade!
Parent/Guardian Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian Phone Number
*
E-mail
*
example@example.com
Medical or other information we need to know. (Please include any food allergies.)
*
EMERGENCY CONTACTS (other than listed above)
*
Please include Name and Phone Number
AUTHORIZED PICK UP
*
Who is authorized to pick up your child? (Please list full names. Only individuals listed here will be allowed to pick up your child unless prior written notice is given.)
DOES YOUR CHILD NEED TRANSPORTATION? Please note, there are limited spots for transportation. They will be filled on a first-come, first served basis.
*
YES
NO
"Is there anything else you'd like us to know to help your child have the best experience at VBS? (Learning styles, social concerns, special interests, recent life changes, etc.)"
*
PUBLICATION (PHOTO RELEASE)
I hereby irrevocably grant to The Salvation Army, its successors and assigns, its agents and those by whom it is commissioned, the absolute, unrestricted and unlimited license, right, permission and consent to use and re-use, disseminate, copyright, print, reproduce, publish and republish, for any and all trade purposes or commercial or other advertising or public purposes, and in any and all advertising, publicity, display, publication or media, my name, signature, and likeness, and any portraits, pictures, photographic prints or other representations of me, or in which I may appear, or any reproductions or sketches thereof or parts thereof, photographic or otherwise, with such additions, deletions, alterations or changes therein as you in your discretion may make, either separately or together with my name or a fictitious name, or the name of another person, with or without any statements or testimonials made by me, or authorized by me which you may, in your discretion, prepare for use in connection therewith. I warrant that I have not limited or restricted the use of my name or photograph to the use of any organization or person. I, the parent or guardian of the person who executed the foregoing release, for good and valuable consideration received by me from you, the receipt hereof I hereby acknowledge, hereby join in and consent to the above release and the execution thereof by my child (ward).
*
YES
NO
Submit
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