VBS 2013 Registration

New Life Community Church - VBS 2013
Primary Contact:
Contact Phone #
E-mail
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Child Name

First NameLast Name
Child Special Needs
Birth Date

MonthDayYear
Grade Level
Child Name #2

First NameLast Name
Child Special Needs
Birth Date

MonthDayYear
Grade Level
Child Name #3

First NameLast Name
Child Special Needs
Birth Date

MonthDayYear
Grade Level
Child Name #4

First NameLast Name
Child Special Needs
Birth Date

MonthDayYear
Grade Level
Photo / Video Agreement
Release Statement

I (the undersigned) hereby consent to the photographing of my child and the recording of his/her voice and the per petual right to the use of these photographs and/or recordings singuarly or in conjunction with other photographs and/or recordings for New Life media and news videos. I understand that the term "photograph" as used herein encompass both still and motion picture footage. This release also includes the use of child's name or likeness

I hereby release New Life and their direction, staff, volunteers and employees from all claims of every kind on account of such use.

I am the parent/legal guardian of child(ren) listed. By signing, I approve of this release and all the terms and acknowledge that said consent and release is irrevocable.
Should be Empty: