VBS REGISTRATION:

Please note, a registration form MUST be filled out and signed in order for participation in VBS. You may either use this format, completing all appropriate boxes, or click to the link on the previous page to print out a pdf.

1.
*

Child's LAST Name:

2.
*

Child's FIRST Name:

3.
*

Birth date

4.
* Grade Completed
5.
*

Street Address

6.
*

City

7.
*

State

8.
*

ZIP

9.
E-Mail (for VBS updates/information)
10.
Church Affiliation/Name
11.
*

Parent(s) name(s)

12.
* Home/Cell Phone
13.
Cell Phone
14.
* Brought by Name
15.
* Phone
16.
* Emergency Name and Relationship
17.
* Emergency Phone
18.
* Allergies/Special Information
19.
* I hereby release Trinity Evangelical Covenant Church (TECC), its staff, employees and officers from any and all liability in the event of injury or incident while participating in VBS. I also give consent To TECC to obtain necessary emergency medical attention in case of sickness or injury to my child.
20.
I agree that TECC may record (audio/video) or photograph my child during their participation in the activity. I agree that TECC will be able to us them, in whole or in-part, whether in original or modified form in any manner; media or social media, including without limitation or compensation, for the purpose of advertising, promoting and publicizing TECC whether during the activity or thereafter.

* Enter Your Email Address: