VBS Registration

Parent/ guardian *

First Name

Last Name

Phone *

(###)

###

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Emergency contact *

First Name

Last Name

Phone *

(###)

###

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Child 1

First Name

Last Name

Child 2

First Name

Last Name

Child 3

First Name

Last Name

Child 4

First Name

Last Name

Child 5

First Name

Last Name

Permissions *

I give Heart of the Shepherd permission to photograph and video the above named minor child/children for any lawful purpose associated with the Vacation Bible School Program.

I give permission to Heart of the Shepherd to secure emergency medical treatment for the above named minor child/children while participating in Vacation Bible School.

Name

First Name

Last Name

Phone of authorized person

(###)

###

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