Spring Grove Community Vacation Bible School

Full Name

Nickname

Birthday (MM/DD/YYYY)

AGE (as of July 14, 2017)

12 years old
13 years old
14 years old
15 years old
16 years old
17 years old

Grade Completed (as of July 14, 2017)

6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade

Parent/Guardian Name

Mailing Address:

Phone Number

E-Mail

ALLERGIES Food/Medical

EMERGENCY CONTACT NAME

EMERGENCY CONTACT PHONE

Home Church

Sacred Heart Catholic Church - SG
St. Paul Lutheran Church - SG
Other

Comments

A PARENT/GUARDIAN MUST READ AND AGREE TO THE RELEASES BELOW BEFORE SUBMITTING THIS ELECTRONIC REGISTRATION FORM.

MEDICAL / PHOTO RELEASE

By submitting this form to register my child for Spring Grove Community VBS, I have read and agree to the following: I will be responsible to physically sign a release upon arrival and/or participation of my child in/at VBS. MEDICAL RELEASE: I hereby give my permission for my child to fully participate in Spring Grove Community VBS. I hereby release on behalf of myself and my child, Spring Grove Community VBS, Sacred Heart Catholic Church, and St. Paul Evangelical Lutheran Church, its agents, employees, and volunteers from any and all liability arising out of or connected to these events, including personal injuries which my child might sustain. I understand that I will be notified in case of serious injury or illness. However in the event that I cannot be reached, I hereby give permission for my child named above to be medically treated by a physician or medical facility as appropriate. PHOTO RELEASE: I hereby give Spring Grove Community VBS, Sacred Heart Catholic Church, and St. Paul Evangelical Lutheran Church permission to publish in print, electronic, or video format the likeness or image of my child or audio recordings of my child. I release all claims against Spring Grove Community VBS, Sacred Heart Catholic Church, and St. Paul Evangelical Lutheran Church with respect to copyright ownership and publication including any claim for compensation related to use of the materials. Images, video and audio recordings of my child taken or recorded can be used in print, broadcasting and other forms of advertising; brochures, newsletters and other publications; on the Spring Grove Community VBS website, Sacred Heart Catholic Church website, and St. Paul Evangelical Lutheran Church website; and in other activities to promote Spring Grove Community VBS and partnering churches (Sacred Heart Catholic Church and St. Paul Evangelical Lutheran Church) and inform the public about Spring Grove Community VBS and the partnering churches. These photos, video and other images or recordings may be used by Spring Grove Community VBS and partnering churches without payment of fees, royalties or other remuneration. By clicking "submit" on this form, I agree to the above terms.

I AM THE PARENT/GUARDIAN OF THIS TEEN VOLUNTEER.

YES
NO