Enter the following information to register your child for VBS

Parent/Guardian Name *
Parent/Guardian Name
Address *
Address
Please provide your address.
Parent/Guardian Emergency Contact Number *
Parent/Guardian Emergency Contact Number
In the event of an emergency, how can we reach you by telephone?
How many children between the ages of 5 and 11 will you be bringing to VBS?
Name of Child #1 *
Name of Child #1
How old is the first child?
Name of Child #2
Name of Child #2
How old is the second child?
Name of Child #3
Name of Child #3
How old is the third child?
Name of Child #4
Name of Child #4
How old is the fourth child?
Name of Child #5
Name of Child #5
How old is the fifth child?
Name of Child #6
Name of Child #6
How old is the sixth child?
Photography/Video Release *
I agree that Perry First Assembly may use photographs and/or video taken of my child during VBS for promoting VBS and Perry First Assembly but will not otherwise sell said photos and/or video.
Liability Release *
I agree to not hold Perry First Assembly, its staff, or its registered and participating volunteers liable for any lost possessions or injuries which may arise despite reasonable attention and precaution from the staff and volunteers of Perry First Assembly.