Hazelwood Baptist Church 2010 Vacation Bible School
On-Line Registration Form

Child's Name: Date of Birth: Last Grade Completed:

Parents Name: Home Phone: Cell Phone:

Church Member: Where:      Parents E-mail Address: 

Mailing Address: Street Address(if different)

City: State: Zip Code:

Emergency Contact: Phone:

Authorized to Pick Up Child at church:

Allergies, Special Needs, etc.:

Register additional children in the same family:

Child's Name: Date of Birth: Last Grade Completed:

Allergies, Special Needs

Child's Name: Date of Birth: Last Grade Completed:

Allergies, Special Needs

Child's Name: Date of Birth: Last Grade Completed:

Allergies, Special Needs

Permission to Photograph Child(ren): (please read and indicate if you agree or disagree) I hereby give my permission for a church rep., employee, or volunteer of Hazelwood Baptist Church to take pictures and/or video of my child(ren) named above. Pictures may be candid, or posed and will be used for a variety of communication and identification mediums to include, but not exclusively, such things as brochures, databases, slide shows, Hazelwood Baptist Church web site, and posters.

I agree for my child(ren) to be photographed

I do not wish for my child(ren) to be photographed

Click to sumbit registration.  .