VBS Registration 2023 • Countryside Covenant Church

Registration Information

First Name

Last Name

Gender

Parent/Guardian Name

Date of Birth

School Grade (2023-24) *

Mobile Number *

Home Address

Home State

Home City

Home Zip Code

Email Address *

Allergies

Shirt Size

Youth Small

Youth Medium

Youth Large

Youth XL

Adult Small

Adult Medium

Special Needs (medical and/ or developmental)

Name of person picking your child up from VBS and relation to child

Emergency Care Permission

If necessary for my child to be taken for emergency treatment to McPherson Hospital, I hearby give permission to do so. I release Countryside Covenant Church, its agents, or volunteers from liability realizing that reasonable safety precautions will be taken.

I understand and agree to the above agreement. Please check the appropriate box and type your name below.

I Accept

I Decline

Signature (type name) *

Date

Social Media/Website Permission

Unless notified, in writing, to the contrary, Countryside Covenant Church has permisson to use my child's name, likeness, image, voice and/or appearance, which may be embodied in any photos, videos, digital images, and the like, taken or made during any Church activities. Please note that when we post pictures on social media or the website we do not post your child's name.

I understand and agree to the above agreement. Please check the appropriate box and type your name below

I Accept

I Decline

Signature (type name) *

Date