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Registracion del Participante

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Zionsville Christian Church

Location

120 N. 9th Street

Zionsville, IN 46077

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Contact Katie Longman:

vbs@zionsvillechristian.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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Secondary contact name

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Secondary contact relationship

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Secondary contact phone

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Nombre de recogida alternativo

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Teléfono de recogida alternativa

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Cuéntanos sobre tu participante

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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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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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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