Register me for Zoomerang!
Childs name
Age of Child
Last Grade completed
Address
Address
Street Address Line 2
City
State
Zip
ParentGuardian
Phone
Email
example@example.com
Emergency contact
Relationship to child
Phone
Who can pick up your child? Name and Relationship.
Name of home church
Food Allergies: List
Medical Concerns: Explain
PERMISSION TO USE IMAGES AND VIDEO
I hereby grant permission for The Tabernacle to record sounds, images, or video of my child while attending this VBS Program. I also give permission for The Tabernacle at its sole discretion, to use these sounds, images, or videos in publications (including print, websites, and social media in relation to this VBS program.
Name of Child
PARENTGUARDIAN SIGNATURE
DATE
/
Month
/
Day
Year
Date
Submit
Should be Empty: