Child's LAST Name *

Child's FIRST Name *

Sex *MaleFemale

Birtdate *

Baptismal Date

Date your child was baptized, if applicable.

Student's Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Student Email Address

Student Phone

Father's FIRST Name

Father's LAST Name

Father's Email Address

Father's Phone

Mother's FIRST Name

Mother's LAST Name

Mother's Phone

Mother's Email Address

Does your child have any dietary restrictions or allergies?

Is there anything else we need to know?

Medical Release *AgreeI give permission for the staff to administer basic first aid to my child (named above) in the event of an injury. I understand that the staff will contact emergency services in the event of a significant injury and all expenses for such emergency services will be paid by me.

Photo Release *AgreeI hereby grant permission to copyright and use photographs/videos taken of the minor designated above in any manner or form for any purpose lawful at any time. I waive the right that I may have to inspect of approve the finished product or written copy, that may be used in conjunction therewith, or the use to which it may be applied.

Permission to attend. *AgreeI give permission for my child (named above) to attend Catechism Class. I understand that the information I give for this registration will only be used by the VBS hosting church.

Register for Catechism Class