VBS Registration – Northside Church of Christ

Rocky Railway Vacation Bible School 2022
Children ages 3-17
August 1 – 5th, 6:00 PM-8:30 PM

Child's First & Last Name *

Child's Gender *

Child's Age *

Child's Date of Birth *

Last Grade of School Completed *

Medical Condition/Allergies *

Parent/Guradian's Full Name *

Address *

Phone Number *

E-Mail Address *

Emergency Contact's Name *

Leave blank if same as parent/guardian

Emergency Contact Phone Number *

Leave blank if same as parent/guardian's number

Permission to use photograph and/or video? *

Yes, I grant permission for my child's photograph and or video to be taken and or published as described
No, I do not grant permission for any photography or video of my child

I grant Northside Church of Christ, its representatives, the right to take photographs and/or videos of my child in connection with Vacation Bible School. I authorize Northside Church of Christ its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that Northside Church of Christ may use such photographs/videos of my child with or without the child’s name and for lawful purpose, included for example such purpose as publicity, illustrations, advertising and Web content.

Alternative Hand-written Form (Requires Microsoft Word)

Please print and bring completed form to Northside Church of Christ.

2022-VBS-Registration-Forms Download