VBS REGISTRATION

Lynnville United Methodist Church, Lynnville, Tennessee

VACATION BIBLE SCHOOL REGISTRATION 

(If transportation is needed Registration needs to be mailed in or contact made with VBS Director 1 Week prior to VBS) 

June 20^th -23^rd, 2017     1 – 4 PM

 

*Student First Name: _________________________________________________________   

*Student Last Name:  _________________________________________________________   

Age:  ______________            Gender:  ____Male   ____ Female

Grade just finished: _____________________________   

               

Allergies: __________________________________________________________________

Medical Issues or Special Needs: ________________________________________________     

___________________________________________________________________________       

*Parent Name (first and last): _________________________________________________   

*Address: ________________________________________________________________________  

*City: ______________________________/State______________     

*Zip: ______________________________________________________________________  

*Email: ____________________________________________________________________ 

*Home Phone Number:_______________________________________________________      

Cell Phone Number/ Other:__(______)_______._______________(_____)_______.________   

 

Emergency Contact (first and last name): ________________________________________

Emergency Phone: __________________________________________________________

Alternate Pickup (first and last name): ___________________________________________

Alternate Pickup Phone: ______________________________________________________  

General Information (if needed): ________________________________________________________           

 

Medical Release: I give my permission for the VBS staff to administer basic first aid to my child (named above) in the event of an injury. I understand that the VBS staff will contact emergency services in the event of a significant injury and all expenses for such emergency services will be paid by me.

 

Photo Release: I hereby grant the above named church permission to copyright and use photographs/videos taken at VBS of the minor designated above in any manner or form for any purpose lawful at any time. I waive any right that I may have to inspect or approve the finished product or written copy, that may be used in conjunction therewith, or the use to which it may be applied.

 

Permission to Attend: I give permission for my child (named above) to attend the Vacation Bible School (VBS) listed above. I understand that the information I give for this registration will only be used by the VBS hosting church, and that all registration information will be removed from the hosting site by December 31 of this year. 

Parent/Guardian Signature:______________________________                                              Date: _____/_______/2017

 

Please Print Parent/Guardian Name   ____________________________