Zion Baptist Church
Register me for Mystery Island Vacation Bible School, Mon.-June 6th through Fri.-June 10th, 2023!
Child’s name ____________________________________________________________ Age: ___________
Gender: Male _____ Female _____ Birthdate _____/_____/_____ Grade Completed ______________
Address __________________________________ City _______________________ State _____ Zip ______
Parents/Guardian__________________________________________ Home phone ____________________
Work phone______________________ Cell phone____________________ Email _____________________
Emergency contact ________________________________________________________________________
Relationship to child ___________________________________________ Phone: _____________________
Who can pick up your child?_________________________________________________________________
Name of home church ______________________________________________________________________
Food allergies Y_____ N_____ List __________________________________________________________
Medical concerns Y___ N___ Explain _________________________________________________________
Please mail completed registrations in already stamped envelope by 05/23!
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*Please See Reverse Side
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Register me for Mystery Island Vacation Bible School, Mon.-June 6th through Fri.-June 10th, 2022!
Child’s name ____________________________________________________________ Age: ___________
Gender: Male _____ Female _____ Birthdate _____/_____/_____ Grade Completed ______________
Address __________________________________ City _______________________ State _____ Zip ______
Parents/Guardian__________________________________________ Home phone ____________________
Work phone______________________ Cell phone____________________ Email _____________________
Emergency contact ________________________________________________________________________
Relationship to child ___________________________________________ Phone: _____________________
Who can pick up your child?_________________________________________________________________
Name of home church ______________________________________________________________________
Food allergies Y_____ N_____ List __________________________________________________________
Medical concerns Y___ N___ Explain _________________________________________________________
*Please See Reverse Side
Please mail completed registrations in already stamped envelope by 05/23!
PERMISSION TO USE IMAGES AND VIDEO
I hereby grant permission for Zion Baptist Church, Irvona, Pa, to record sounds, images, or video of my child, (Child’s Name) _______________________________________________________, while attending The Mystery Island Vacation Bible School. I also give permission for Zion Baptist Church, Irvona, PA, at its sole discretion, to use these sounds, images, or videos in publications (including print, websites, and social media platforms) owned by Zion Baptist Church in relation to The Mystery Island Vacation Bible School.
_________________________________________________________________________________________ PARENT/GUARDIAN SIGNATURE DATE
I do not grant permission for Zion Baptist Church, Irvona, Pa, to record sounds, images, or video of my child,
(Child’s Name) _______________________________________________________, while attending The Mystery Island Vacation Bible School.
_________________________________________________________________________________________ PARENT/GUARDIAN SIGNATURE DATE
Please mail completed registrations in already stamped envelope by 05/23!
*Please See Reverse Side
===============================================================================
PERMISSION TO USE IMAGES AND VIDEO
I hereby grant permission for Zion Baptist Church, Irvona, Pa, to record sounds, images, or video of my child, (Child’s Name) _______________________________________________________, while attending The Mystery Island Vacation Bible School. I also give permission for Zion Baptist Church, Irvona, PA, at its sole discretion, to use these sounds, images, or videos in publications (including print, websites, and social media platforms) owned by Zion Baptist Church in relation to The Mystery Island Vacation Bible School.
_________________________________________________________________________________________ PARENT/GUARDIAN SIGNATURE DATE
I do not grant permission for Zion Baptist Church, Irvona, Pa, to record sounds, images, or video of my child,
(Child’s Name) _______________________________________________________, while attending The Mystery Island Vacation Bible School.
_________________________________________________________________________________________ PARENT/GUARDIAN SIGNATURE DATE
*Please See Reverse Side
Please mail completed registrations in already stamped envelope by 05/23!