VBS Registration Form 2014.pub
Registration Form ~ VBS 2014
August 44-8, 2014 Child’s Name _____________________________________ Age __________ Grade Completed_________ Parent/Guardian Name _____________________________________________________________________ Address ________________________________________________________________________________________ Home Phone ________________ Cell Phone _________________ E-mail ____________________________ Church Affiliation _________________________________________________________________________ Emergency Contact ________________________________ Phone _________________________________ Please list important information about your child (i.e. allergies to foods or medicine, physical or emotional disabilities, etc.) _________________________________________________________________________________________ _________________________________________________________________________________________
______ I grant to Holy Innocents’ Episcopal Church of Valrico, Florida, its representatives and employees (Initials)
the right to take photographs of my child and their property in connection with the above-identified subject.
If someone other than parent/guardian listed above will pick up child, please fill out the following information: Person responsible for pickup after VBS _______________________________________________________ His/her phone number _________________________ Relationship to child_____________________
Holy Innocents’ Episcopal Church 604 N. Valrico Road ~ Valrico, FL 33594 (813) 689-3130 www.hiepiscopal.org
August 44-8, 2014 Child’s Name _____________________________________ Age __________ Grade Completed_________ Parent/Guardian Name _____________________________________________________________________ Address ________________________________________________________________________________________ Home Phone ________________ Cell Phone _________________ E-mail ____________________________ Church Affiliation _________________________________________________________________________ Emergency Contact ________________________________ Phone _________________________________ Please list important information about your child (i.e. allergies to foods or medicine, physical or emotional disabilities, etc.) _________________________________________________________________________________________ _________________________________________________________________________________________
______ I grant to Holy Innocents’ Episcopal Church of Valrico, Florida, its representatives and employees (Initials)
the right to take photographs of my child and their property in connection with the above-identified subject.
If someone other than parent/guardian listed above will pick up child, please fill out the following information: Person responsible for pickup after VBS _______________________________________________________ His/her phone number _________________________ Relationship to child_____________________
Holy Innocents’ Episcopal Church 604 N. Valrico Road ~ Valrico, FL 33594 (813) 689-3130 www.hiepiscopal.org
