Ministries – Central United Methodist Church

Student's Name *

Student's Date of Birth *

Student's Age *

Last School Grade Completed *

Home Church (If Any)

Parent/Guardian Name *

Parent/Guardian Phone Number *

Address *

Email *

Special Needs/Medical Information/Allergies *

Are any family members helping with To Mars and Beyond VBS at Central? *

Yes
No

If Yes, Who?

Names of People allowed to pick them up from VBS *

(2) Emergency Contacts *

Central United Methodist Church/VBS has my permission to use my child’s photograph publicly in VBS materials. I understand the images may be used in print publications, presentations, and social media. I also understand that no royalty, fee or other compensations shall become payable to me by reason of such use. *

Yes
No

By entering you full name in the box below, you agree to the Photo Release Waiver Agreement Above *

Adult Ministries

Children's Ministries

Youth Ministries

Music Ministries

Worship Ministries