I have read the medical release in the PDF document listed above
and accept the terms .  

 Child's Name: 

Boy     or    Girl

Child's Age: 3   4   5   6   7   8   9   10 years old

              Parent's Name(s): 

Parent's Phone Number(s): 

     Parent's Email Address: 

 Parent's Mailing Address:  

Electronic and Photo Release: I give permission to have my child's
photographs taken during VBS and to use the photo for any of the following;
appearance in a video, appearance in a picture to be used in a publication,
multimedia presentation or the church's website.

Yes No

Comments:

The person submitting this form represent that they are a parent or legal
guardian of the child named herein, are at least 18 years of age and are
legally authorized to submit this form on behalf of the child.