First Baptist Church LaFollette

Director: Sue Bray

Register me for Scuba VBS June 24-28, 2024

Child’s name ______________________ Gender: Male __ Female __ Birthdate __/__/____ Grade completed _______________
Address ____________________________________________________ City _________________ State ____ Zip __________
Parent/Guardian____________________________ Phone ________________ Email __________________________________
Relationship to child ________________________  Phone ________________________
Who can pick up your child?_________________________________________________________________________________
Name of home church _____________________________________________________________________________________
Food allergies Y_____ N_____ List___________________________________________________________________________
Medical concerns Y___ N___ Explain_________________________________________________________________________

PERMISSION TO USE IMAGES AND VIDEO

I hereby grant permission for FIRST BAPTIST CHURCH of LAFOLLETTE to record sounds, images, or video of my child, (NAME)_________________________________________while attending this VBS program. I also give permission for FIRST BAPTIST CHURCH of LAFOLLETTE, at its sole discretion, to use these sounds, images, or videos in publications (including print, websites, and social media platforms) owned by the above named church in relation to this VBS program.

_________________________________________________________ __________________________
_{PARENT/GUARDIAN SIGNATURE                                                                      DATE}