Participant Name *

First Name

Last Name

Phone Number *

(###)

###

####

Participant Birthdate *

MM

DD

YYYY

Permissions *

I give my permission to have my child photographed or filmed for in-church historical and publicity purposes.

I give my permission to have my child’s photo published online (no identifying information attached!) on our church website or Facebook page.

I agree to transfer the $30 VBS registration fee to treasurer1@stalbertunited.ca to confirm this registration.

I agree that all of the information submitted here is correct.