VBS Registration

Please Complete this Form for Each Child

3 YRS (Potty Trained) - 6th Grade. VBS is from Monday July 14th to Friday July 18th, 2008

Parent or Guardian Information:

	Full Name(s)		Required
	Address		Required
	City		Required
	State		Required
	Zip Code		RequiredInvalid format.Invalid Format

Phone Number for Emergencies		RequiredInvalid Format
Secondary Number		Invalid format.
Do you have a Church Home?		YES NO

People allowed to pick up child from VBS.

Required

Child's Information:

	Full Name LIST FIRST AND LAST NAME		Birthdate 00/00/08		Grade AS OF 09/08		Known Allergies PEANUT BUTTER, ETC.		Special Needs WE SHOULD BE AWARE OF
	Required		RequiredInvalid Format		Required

Required By checking this box you agree to the following...

I authorize all medical treatment necessary as prescribed by the attending physician and/or paramedics for my child and waive my right to informed consent of treatment in my absence. This waiver applies only in the event that neither parent/guardian can be reached in case of an emergency. I release Christ's Outreach (COC) and individuals from liability in case off accident during activities related to COC, as long as normal safety procedures have been taken. I hereby give permission for images of my child, captured during VBS through video, photo and digital camera, to be used for printing articles, publications, flyers, posters, promotional materials of various Children's Ministries at COC or on COC's web site and waive any rights of compensation or ownership thereto.