Registration Form for VBS 2023

Please choose one:

Student
Adult

Name:

Home Church (if any)

If Student, name of parent/guardian

If student, is parent attending VBS

Adult/parent/guardian Address

Adult/parent/guardian email address

Adult/parent/guardian phone number

STUDENT INFORMATION

Emergency Contact (Name and phone number)

Are they attending VBS?

Additional emergency contact (name and phone number)

Are they attending VBS?

Food Allergies/Restrictions

Special needs/Medical information?allergies/Other important information to know about student

Last Grade Completed

Age

Date of birth

Name of person(s) who may pick up this child from VBS

Photo Release: Brick Presbyterian Church/VBS has my permission to use my child's photograph - as well as mine if I'm attending - 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 and date: