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Participant Registration

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Registro en Español

Zionsville Christian Church

Location

120 N. 9th Street

Zionsville, IN 46077

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Contact Katie Longman:

vbs@zionsvillechristian.org

First, Tell Us About Yourself:

Parent Information

First Name

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Last Name

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Address 1

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Address 2

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City

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State/Province

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ZIP/Postal Code

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Country

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Contact Phone 1

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Secondary contact name

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Secondary contact relationship

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Secondary contact phone

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Alternate Pickup Name

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Alternate Pickup Phone

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Tell Us About Your Participant

First Name

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Last Name

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Grade Entering

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Gender

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Date Of Birth

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Allergies

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Medical Concerns

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Do you have friends you would like to be placed with? We will do our best to group selected friends together in the same crew, but we cannot promise all requests will be possible.

Friend 1 First Name

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Friend 1 Last Name

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Friend 2 First Name

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Friend 2 Last Name

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Friend 3 First Name

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Friend 3 Last Name

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Comments

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I give my permission for the VBS staff to administer basic first aid to the child listed 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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I hereby grant Zionsville Christian Church my permission to copyright and use photographs/videos taken at VBS of the child listed 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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