VBS Registration Form

Student's Name

Parent/Family/Guardian Name

Address

Email address

Phone numbers (home/cell/work)

Date of Birth

Age

Last school grade completed

Home Church (if any)

Emergency Contacts (Name & Phone number)

Emergency contacts (Name & phone number)

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

Photo Release: Brick Presbyterian Church/VBS has my permission to use my child's photograph 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: