Parent name *

First Name

Last Name

Primary phone *

(###)

###

####

Additional phone

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency contact #1 phone *

(###)

###

####

Emergency contact #2 phone

(###)

###

####

Child #1 date of birth *

MM

DD

YYYY

Child #2 date of birth

MM

DD

YYYY

Child #3 date of birth

MM

DD

YYYY

Child #4 date of birth

MM

DD

YYYY

Photography release *

Your permission is completely optional. Occasionally, a Beautiful Savior representative may take photos for use on the church website, publications, and social media. Names or other identifying information are never shared. If you wish to grant permission to have your child photographed, please indicate so here. Please list any exceptions in the text box below.

Child #1 - I give permission

Child #1 - I give partial permission, as explained below

Child #1 - I do not give permission

Child #2 - I give permission

Child #2 - I give partial permission, as explained below

Child #2 - I do not give permission

Child #3 - I give permission

Child #3 - I give partial permission, as explained below

Child #3 - I do not give permission

Child #4 - I give permission

Child #4 - I give partial permission, as explained below

Child #4 - I do not give permission

Emergency release *

In the event of illness or accident to a child or children of mine attending Beautiful Savior's Vacation Bible School, which in the judgment of the supervisor or other adult leader would seem to demand medical attention, I hereby authorize the said person to summon medical help at my expense if I cannot be promptly reached by phone. I further authorize the supervisor or other adult leader to cause my child's transportation to a place where appropriate medical aid can be rendered, if in his or her judgment such transportation is necessary. If available, I would prefer that the doctor listed below be called at the number provided, but otherwise the supervisor or other adult leader shall use his or her own judgment as to the doctor to be called.

Agree

Disagree

Date *

MM

DD

YYYY