VBS 2019 Preregistration Form

Roar - VBS 2019 Preregistration Form

August 5-9, 2019 - Dinner at 5:30p - VBS from 6:00p-9:00p - Ages 3 through 6th Grade

* Indicates required field

Parent/Guardian Name *

First

Last

Home Church Affiliation *

Phone Number *

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Emergency Contact Name *

First

Last

Emergency Contact Phone Number *

Student 1 - Name *

First

Last

Student 1 - Date of Birth *

Student 1 - Grade in Fall (Select One) *

Student 1 - Gender (Select One) *

Allergies/Medical Concerns *

Student 2 - Name *

First

Last

Student 2 - Date of Birth *

Student 2 - Grade in Fall (Select One) *

Student 2 - Gender (Select One) *

Allergies/Medical Concerns *

Student 3 - Name *

First

Last

Student 3 - Grade in Fall (Select One) *

Student 3 - Date of Birth *

Student 3 - Gender (Select One) *

Allergies/Medical Concerns *

Photo Release
Old Zion Wesleyan Church has my permission to use my or my child(ren)’s photograph publicly. I understand that 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.

Photo Release Consent *

I agree I do not agree

Submit