Parent/Guardian Name * First Name Last Name Will you be attending? Yes No Student's Name * First Name Last Name Age * What's the last grade of school your student has completed? Kindergarden 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Emegergency Contact Phone No.: * (###) ### #### How did you hear about us? Facebook Website Word of Mouth Other Special Needs/Allergies/Medical Information/Other * Name(s) of person(s) who may pick up this child from VBS * Photo Release: Herscher Christian Church 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 my by reason of such use. * Yes No Photograph Release Acknowledgment: * Thank you!
