Registration Please complete a registration form for each child. OK Question Title * 1. Child's name OK Question Title * 2. Child's gender OK Question Title * 3. Child's age OK Question Title * 4. Date of birth OK Question Title * 5. Last school grade completed OK Question Title * 6. Parent/Contact name OK Question Title * 7. Address OK Question Title * 8. Parent/Contact phone number(s) OK Question Title * 9. Parent/Contact email address OK Question Title * 10. Home church OK Question Title * 11. Allergies or other medical conditions OK Question Title * 12. Emergency name and phone number OK Question Title * 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. Yes No OK Question Title * 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. Yes No OK Question Title * 15. Referred by OK DONE