Explorer Registration Form
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Student's Name *
Parent/Family/Guardian Name *
Address *
E-mail Address *
Home Phone *
Cell Phone
Work Phone
Date of birth *
MM
/
DD
/
YYYY
Age *
Last school grade completed *
Home Church (if any)
Special Needs/Allergies/Medical Information/Other
Emergency Contact #1 Name *
Emergency Contact #1 Phone Number *
Emergency Contact #2 Name *
Emergency Contact #2 Phone Number *
Name(s) of person(s) who may pick up this child from VBS *
Photo Release: Faith Lutheran Church/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. Parent/Guardian's name and date:
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