VBS Registration Child's Name* First Last Age*Date of Birth* MM DD YYYY Grade Just Completed:*Pre-K (4 or 5 yr olds)K1st2nd3rd4th5th6th7th8th9th10th11th12thGender*BoyGirlT-Shirt Size (Select One):*Youth-X SmallYouth-SmallYouth-MediumYouth-LargeAdult-SmallAdult-MediumAdult-LargeAdult-X LargeAdult-XX LargeChild's Image Consent*I hereby grant/do not grant permission for my child's image to be included in pictures, videos, promotional materials, and publications connected with South River Baptist Church. I grant permission I do not grant permission Parent/Guardian Name* First Last Address* Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone*Emergency Contact Information - Name, Relationship, Phone#*Does Your Child Have Allergies?* Yes No If Yes to Allergies please specifyAny special needs?Who many pick up your child at the end of VBS other than Parent or Guardian? List all names of those with permission.Is there a friend your child would like to be with in VBS?Name of person registering child for VBS*Email of person registering child for VBS* Do you have a church home?* Yes No If Yes, where?