Registration Form

---

Union Church Vacation Bible School July 20, 27 | Aug 3, 10, 17 CHILD’S NAME ________________________________ M / F (circle one) DATE OF BIRTH ____ (D) ____ (M) ________ (Y) (must be 3yrs old by July 20, 2014)

AGE _______ YRS OLD

will be attending the following Sunday (tick all that applies)

[ ] July 20 [ ] July 27

[ ] Aug 3 [ ] Aug 10 [ ] Aug 17

PARENT’S | GUARDIAN’S NAME: ____________________________ MAILING ADDRESS: _______________________________________ CONTACT NO: ______________ EMERGENCY NO: ______________ EMAIL ADDRESS: _________________________________________ ALLERGIES | MEDICAL CONDITION: __________________________ Medical Consent: I (parent / guardian of above named child) give permission for Union Church adult supervisors to secure proper treatment for the health and comfort of my child until I can be reached. Photo Release: I give permission for Union Church, HK to photograph my child at Weird Animals VBS 2014. I give permission to copyright, use and publish the photographs for any lawful purpose including newspaper articles, church publications and the church website.

I have read and understand the above: (sign)_______________________ PRINTED NAME: __________________________ DATE: ___________ One (1) Registration Form per child, including guests. There is NO REGISTRATION FEE, but you are welcome to donate $200 to St. Mary’s Home for the Elder, which we will be visting in the summer.