Brock UMC Vacation Bible School Registration Form

* indicates required field

Child's Name*
Child's Sex MaleFemale

Contact Information

Parent/Guardian*
Address*
Parent/Guardian Email*
Phone*
T-Shirt Size (Please indicate youth or adult)

Child's Age Information

Date of Birth
Age
Last School Grade Completed

List any Allergies/Medical/General Information

Emergency Contact Name 1
Emergency Contact Phone 1

Emergency Contact Name 2
Emergency Contact Phone 2

Name(s) of Person(s) who may pickup this child from Vacation Bible School*

Permission to Use Photograph

I grant to Brock United Methodist Church, the right to take photographs of me and my family in connection with BUMC events. I authorize Brock United Methodist Church, its assigns and transferees to copyright, use and publish the same in print and/or electronically.

I agree that Brock United Methodist Church may use such photographs of me and my child(ren) with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content.

Please note that the default answer is yes so change it if you do not want to grant permission.

I Grant Permission to Use Photograph* YesNo