Child's Name *

First Name

Last Name

Parent/Guardian Contact #

(###)

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Child's Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact

(###)

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Checkbox

Goodview Trinity Church has the right to photograph/film the minors above in any manner for any lawful purpose. By signing this form, I give permission to Goodview Trinity Church to use and display any said images for promotional use of the church or activities supported by the church. Goodview Trinity Church will not be held liable for any injury to child or damage to child's property while participating in this VBS program. I also give permission to Goodview Trinity Church to seek emergency medical attention for my child in the case of an emergency, and agree to pay all expenses incurred related to that care.