St. Peter's (Lischey's) United Church of Christ

Parent/ Guardian Phone:

Parent/ Guardian Name:

Parent/ Guardian Email:

Name of additional guardian (18 years or older) if parent is unable to attend/ pickup:

Guardian's Phone:

Family Address:

Emergency Contact Information (Name, Phone) if different from above:

**NOTICE: Please let us know about any FOOD ALLERGIES or ALLERGIC REACTIONS, such as bee stings, for each child along with their name and age.**

Child's Name (First and Last)/ Age:

Child's Name (First and Last)/ Age:

Child's Name (First and Last)/ Age:

Child's Name (First and Last)/ Age:

Child's Name (First and Last)/ Age:

PHOTO RELEASE for Vacation Bible School (VBS): I understand and acknowledge that while my child(ren) is at Vacation Bible School (VBS) they may be a part of pictures or film taken by St. Peter's Lischey's UCC. I hereby release and give my permission to St. Peter's Lischey's UCC to publish any such image of my child(ren) in any combination of still picture or film format on our church website.

I DO give permission for my child(ren) to be filmed or photographed.
I DO NOT give permission for my child(ren) to be filmed or photographed.

By clicking "Submit", you are registering your family and agree to the following: You agree to release St. Peter's Lischey's UCC, its staff, directors, volunteers and anyone connected or associated with the church from any liability for injuries/illness to your family arising out of his/her participation in this event.