Vacation Bible School

This field is for validation purposes and should be left unchanged.

Child's Name

First Last

Street Address(Required)

Birth Date(Required)

Last School Grade Completed(Required)

Dad's (Guardian) First and Last Name(Required)

Mom's (Guardian) First and Last Name(Required)

Dad Phone Number(Required)

Mom Phone Number (If using 1 number, use the same as Dad)(Required)

Home Phone(Required)

Home Church(Required)

Please list two relatives, friends or neighbors who will pick up your child and assume responsibility in case of an emergency where you cannot be reached

Name #1(Required)

Phone Number(Required)

Name #2(Required)

Phone Number(Required)

Please List ALL Allergies We Should Be Aware Of

Does Your Child Have any Physical or Developmental Disabilities (This will help us prepare for your child to have the most enjoyable week possible)

Does Your Child Require 1-on-1 Adult Supervision?(Required)

Yes

Would you like to have the music CD?(Required)

Yes

Release Statement

I grant permission to Christ Church Franklin to use photographs taken of my child/ward on the dates and at the location listed below for use in its publications such as newsletters and brochures, and to use the photographs on display boards, and to use such photographs in electronic versions of the same publications or on the church’s web sites or other electronic forms or media.

I hereby waive any right to inspect or approve the finished photographs or printed 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 wave any right to royalties or other compensation arising from or related to the use of the photograph.

I have read this release before signing below, and I fully understand the contents, meaning and impact of this release. I understand that I am free to address any specific questions regarding this release by submitting those questions in writing prior to signing, and I agree that my failure to do so will be interpreted as a free and knowledgeable acceptance of the terms of this release.

Location of photo(s): Christ Church Franklin

Dates: June 16-20, 2025

Signature(Required)