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Registracion del Participante

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Bethany Lutheran Church & Preschool

Location

2501 Beacon Hill Road

Alexandria, VA, VA 22306

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Contact Kimberly Savage:

703-765-8255

office@bethany-lcms.org

Primero, cuéntenos sobre usted:

Información de los Padres

Nombre

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Apellido

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Correo Electrónico

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Dirección 1

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Dirección 2

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Ciudad

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Estado/Provincia

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ZIP/Código Postal

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País

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Teléfono de Contacto 1

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Teléfono de Contacto 2

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Nombre del Contacto de Emergencia

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Relación del Contacto de Emergencia

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Teléfono del Contacto de Emergencia

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Photo Release: I hereby grant Bethany Lutheran Church and Preschool permission to copyright and use photographs/videos taken at VBS of the minor designated above in any manner or form for any purpose lawful at any time. I waive any right that I may have to inspect or approve the finished product or written copy, that may be used in conjunction therewith, or the use to which it may be applied.

Photo Release

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Medical Release: I give my permission for the VBS staff to administer basic first aid to my child (named above) in the event of an injury. I understand that the VBS staff will contact emergency services in the event of a significant injury and all expenses for such emergency services will be paid by me.

Medical Release

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Nombre

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Apellido

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Grado Entrando

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Género

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Fecha de nacimiento

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Talla de Camisa

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Alergias

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Preocupaciones Médicas

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¿Tienes amigos con los que te gustaría estar juntos? Haremos todo lo posible para juntar a los amigos seleccionados en el mismo grupo, pero no podemos prometer que todas las solicitudes serán posibles.

Amigo 1 Nombre

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Amigo 1 Apellido

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Amigo 2 Nombre

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Amigo 2 Apellido

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Amigo 3 Nombre

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Amigo 3 Apellido

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Comentarios

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