Participant *

First Name

Last Name

Mailing Address *

Address 1

Address 2

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Parent/Guardian Name: *

First Name

Last Name

Mailing Address (if different from above)

Address 1

Address 2

City

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Zip/Postal Code

Country

Home Phone

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Work Phone

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Cell Phone *

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Name *

First Name

Last Name

Mailing Address (if different from above)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Phone

(###)

###

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Work Phone

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Cell Phone *

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Checkbox *

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.

Yes I grant permission

No I do Not grant permission