VBS Signups

Child's Name:*
Gender:*
Birthdate:*
Grade Completed:*
Address:*
City:*
State:*
Zip Code:*
Parents / Guardian:*
Home Phone:
Work Phone:
Cell Phone:
Email:*
Emergency Contact:*
Relationship to Child:*
Phone:*
Who Can Pick Up Your Child?*
Name of Home Church:
Food Allergies (Please list)
Medical Concerns (Please explain)
Permission to use images and video:
I hereby grant permission to Community Bible Church to record sounds, images, or video of my child while attending this VBS program. I also give permission for CBC at it's sole discretion, to use these sounds, images or videos in publications (including print, websites, and social media platforms) owned by CBC in relation to this VBS program.
(Parent/Guardian Name & Date)*


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