VBS 2022 Registration - Clear Fork Baptist Church

Child Information

Please provide a registration for each child

Name *

First

Last

Date of Birth *//

Parent/Guardian Information

Name *

First

Last

Email *

Phone

Media Release

I grant permission to Clear Fork Baptist Church, to use my or my child's image (photographs and/or video) for use in Media publications, Church website, or Church social media. I hereby waive any right to inspect or approve the finished photographs or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right to royalties or other compensation arising from or related to the use of the image

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Emergency Contact

Name *

First

Last

Phone *

Medical Concerns or Food Allergies