Green Spring BIC VBS Pre-registration

Green Spring BIC VBS

Pre-Registration
Student Name

First NameLast Name
Age
Date of Birth

MonthDayYear
Date
Gender
Grade Level
Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name 1

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Name 2

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
T-Shirt Size
Authorized person who can pickup the child on dismissal

First NameLast Name
Agreement
1. I authorize the Green Spring BIC, bible study conductor, volunteer personnel to conduct first aid, and medical care in the event of an emergency situation.
2. I release the Green Spring BIC from any liabilities that might happen during the activity and hold them harmless in the event of damages, injuries, or accidents.
Would it be okay if we take photos and videos of the participant during the activity which will be posted in our social media account?
Parent/Guardian Signature
Date Signed

MonthDayYear
Date
Should be Empty:

Green Spring BIC VBS