VBS Registration Form Come and See! 810 West Florida Ave, Melbourne, FL 32901 VBS Registration Form Participant Name Parent/Family/Guarding Name Email Address Address(1) Address(2) City State Zip Primary Phone Secondary Phone Age Last school grade completed Special Needs /Allergies/Medical Information/Other Emergency Contact 1 Phone Emergency Contact 2 Phone Name(s) of Person(s) who may pick up this child from VBS Photo Release: Presbyterian Church of the Good Shepherd VBS has my Permission to use my child's photograph publicly in VBS materials, I understand the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use. Photo Release: Presbyterian Church of the Good Shepherd VBS has my Permission to use my child's photograph publicly in VBS materials, I understand the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use. Yes No Parent/Guardian's Name Approving and submitting information Date Other information you would like us to know 1 + 2 = Submit