Vacation Bible School

"Glow for Jesus"

Monday, June 19th – Friday, June 23th

6:15 pm – 8:30 pm

Student's First Name (required)
Student's Last Name (required)
Age
Grade Last Completed
Select class
Student allergies

Parent/Guardian First Name (required)
Parent/Guardian Last Name (required)
Parent Email (required) Adults should enter their own name.
Primary Phone (required)
Other Contact Phone
Emergency Contact Name
Emergency Contact Phone

MEDICAL RELEASE
In case of emergency, I accept responsibility for any medical treatment required by any of
the above named participants while attending Vacation Bible School at Greater Providence Baptist Church.

PHOTOGRAPHY WAIVER AND RELEASE FORM

We at the Greater Providence Baptist Church collect individual and group photos and testimonials relating to our VBS volunteers, supporters and activities. We use these photographs, videos, profiles and stories for various purposes, such as promotional, advertising, commercial, educational, research and archival purposes. I agree that the Greater Providence Baptist Church may use any image, photograph, voice or likeness, in its promotional materials and publicity efforts without additional compensation. I understand that these photographs, images, video or audio may be retouched or enhanced and may further be used in publications, print ads, electronic media (e.g., video, CD-ROM, Internet/WWW), or other media now known or hereafter created, anywhere in the world. I further understand that by participating in the photography or filming, I release the Greater Providence Baptist Church and its representatives, licensees, employees, photographers, and their designees from any and all liability for any violation of any privacy or proprietary rights.

I accept the terms above. (Form cannot be submitted without acceptance of terms.)