Register for VBS

Family Information

Address

Primary Phone

Alternate Phone

Relationship to Student Father Mother Grandfather Grandmother Great-grandfather Great-grandmother Brother Sister Uncle Aunt Guardian Foster Parent Granduncle Grandaunt Other

Phone Number

Photo Waiver YES NO Waiver: I hereby grant the release permission to use photographs and video footage of myself or child to Pekin Bible Church. Photos and videos can / will be used for the following: social media, websites, advertisements, programs. I understand and agree all media in the church shall become property of Pekin Bible Church. I waive my right to inspect media before release. I hereby hold harmless, release, and forever discharge all forms of claims, demands, and causes of action.

Student Information

Gender

Birth Date

Age Group

Food Allergies

Details

Medical Concerns

Details

Waiver: As a participant/ volunteer/ guardian I release Pekin Bible Church and their volunteer members from any and all claims including claims of negligence resulting in physical injury, illness or property damage what I may suffer, or which may result from my participation in youth events, programs or activities which I / they attend. Safety Waiver

Details

I have more students to register