Student Registration Form
Student's Name
*
Parent/Family/Guardian Name
*
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail Address
example@example.com
Phone Number:
*
Home
Format: (000) 000-0000.
Date of birth
-
Month
-
Day
Year
Date
Age
Last school grade completed
Home Church (if any)
Friends of your child at this church
Special Needs/Allergies/Medical Information/Other:
Emergency Contacts
Name
*
Phone
*
Format: (000) 000-0000.
Name
Phone
Format: (000) 000-0000.
Name(s) of person(s) who may pick up this child from VBS
*
Photo Release:
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.
Parent/Guardian's signature:
Date
-
Month
-
Day
Year
Date
---------- (for church use only) ----------
Assigned Group:
Are family members helping with VBS?
Cokesbury Kids VBS Resources
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Submit
Phone Number:
Work
Format: (000) 000-0000.
Phone Number:
Cell
Format: (000) 000-0000.
Should be Empty: