Child's Name *

First Name

Last Name

Child #2

First Name

Last Name

Child #3

First Name

Last Name

Child #4

First Name

Last Name

Child #5

First Name

Last Name

Parent/Guardian *

First Name

Last Name

Phone

(###)

###

####

Photo/Video Release *

I (we) understand that my child(children) may be photographed or filmed though out the year. These photos/videos may be used within the church building and in church publications such as but not limited to: website, Facebook, Instagram, Newsletter, and brochures. I agree and give permission for the photo/video release for my minor(s) to be used on these church-related platforms.

Yes

No

VBS T-Shirt *

I would like to purchase a VBS t-shirt for my child(ren). Must order by June 16th.

Yes I'd like a T-shirt

No Thanks