Child Name *

First Name

Last Name

Child Date of Birth *

MM

DD

YYYY

Parent Name *

First Name

Last Name

Phone *

(###)

###

####

Photo Release Permission *

I understand that by checking the box below I am granting permission for LifeChange Church Vacation Bible School to photograph my child participating in Vacation Bible School activities. I understand that this consent gives LifeChange Church permission to publish these pictures to their website.

YES, my child can be photographed.

NO, my child cannot be photographed.

Medical Liability Release *

We, the parent/guardian give permission for our child to participate in LifeChange Church Vacation Bible School. We understand that we assume all risks and hazards related to incidental participation, including games and activities related to LifeChange Church Vacation Bible School. We waive, release and absolve any indemnity and agree to hold harmless any and all volunteers of LifeChange Church for any claim arising from any injury (or previous injury) or damage to our child or his property.

Agree