VBS Registration - Student
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Email *
Parent Name(s): *
Address (street, city, state, zip code): *
Phone Number: *
Alternate Phone Number:
Emergency contact (name & phone number) *
People authorized to pick up my child: *
Do you have a church home?
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If you do not have a church home, would you like more information about Ascension?
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I consent to first aid treatment in the event of a medical emergency. *
I understand that unless I otherwise notify vbs@ascensionpgh.com, that I grant Ascension Lutheran Church permission to use photos, videos, and recordings of my child in websites, press releases, social media and other forms of publicity. *

By registering my child, I acknowledge that my child's participation in Vacation Bible School at Ascension Lutheran Church may pose certain risks.  I knowingly and freely assume any such risk and assume full responsibility for my child's participation in VBS.  I agree to release all claims for myself and my child as a parent or legal guardian for the child being registered against Ascension Lutheran Church, its employees and volunteers, and will hold them harmless from any and all liability or demands for personal injury, psychological injury or sickness which may be incurred by my child's participation in VBS and affiliated programs, events, and activities.

Please type your name as an esignature below. 
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