Child Registration

This is where you will register your child for VBS Alive 2014's event, "Stand Firm." This event is held Monday through Thursday, June 16-19 from 6:00 p.m. to 8:00 p.m. each evening. Ages Requirement: 3-Years-Old to 5th Grade (must be potty trained)

Child Information

* First Name :
* Last Name :

List Allergies, Medical, Special Needs (if applicable)

* Grade Entering This Fall

Parent/Guardian Information

* First Name :

* Last Name :

* Address 1 :

Address 2 :

* City :

* State :

* Zip :

* Phone :

Email Address :

* Emergency Contact Name and Number:

Do you attend a local church?

Yes

No

If so, what church do you attend?

* Numerous photographs are taken during the annual VBS Alive event. Photos of children and volunteer are posted on VBS Alive's Facebook page as well as some photographs are used within promotional material.

I give VBS Alive permission to use photographs of myself or my child/children.

I DO NOT want VBS Alive to use photographs of myself or my child/children.

* I agree that in the event medical treatment is required, I authorize the VBS Alive staff, medical doctors or hospital to administer treatment to my child. I assume the responsibiliity and cost for any such treatment. Please attempt to notify me immediately in the event of such an emergency. I hereby exempt VBS Alive and its agents from any liability for any accidental injury to the reigistrant.

Yes, I agree