Please complete a registration form for each child. 

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* 1. Child's name

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* 2. Child's gender

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* 3. Child's age

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* 4. Date of birth

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* 5. Last school grade completed

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* 6. Parent/Contact name

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* 7. Address

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* 8. Parent/Contact phone number(s)

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* 9. Parent/Contact email address

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* 10. Home church

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* 11. Allergies or other medical conditions

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* 12. Emergency name and phone number

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* 13. I hereby give my consent for the child listed above to participate in ROAR VBS at Salt Life Church.  I hereby release from liability and indemnify and hold harmless Salt Life Church, or any volunteers, or agents representing any of these groups.  This release is for any and all liability for personal injury and property losses or damages occasioned by, or in connection with, any activity associated with this event.

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* 14. I hereby give my consent to Salt Life Church to use any photographs and/or videos taken of my child for use in any form of promotional material.  I release the right to view or approve any photographs obtained.

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* 15. Referred by

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