Zion Baptist Church

Register for Vacation Bible School, Mon.-June 10th through Fri.-June 14th, 2024! Just print, fill out and send registration in by      

May 2024

 

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 by 05/24!

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Register me for Vacation Bible School, Mon. June 10 through Fri. June 14, 2024!

 

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 _________________________________________________________

​

 

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 Great Jungle Journey 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 Great Jungle Journey 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 Great Jungle Journey Vacation Bible School. 

 

_________________________________________________________________________________________ PARENT/GUARDIAN SIGNATURE DATE

 

 

Please mail completed registrations in by 05/24!

​

 

 

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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 Great Jungle Journey 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 Great Jungle Journey Vacation Bible School. 

 

_________________________________________________________________________________________ PARENT/GUARDIAN SIGNATURE DATE

​

Please mail completed registrations in by 05/24!