New Wine Ministries - VBS 24 Form

Participant #1

Child's First Name

Child's Last Name

Gender

Grade

Allergies

Participant #2

Child's First Name

Child's Last Name

Gender

Grade

Allergies

Participant #3

Child's First Name

Child's Last Name

Gender

Grade

Allergies

Participant #4

Child's First Name

Child's Last Name

Gender

Grade

Allergies

Parent/Guardian Contact

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Parent/Guardian First Name

Parent/Guardian Last Name

Email

Phone Number

Photo Release

Text Area

Single Choice

Yes, you can use pictures and videos of my child. I hereby grant New Wine Ministries the permission to use my child's likeness in photographs, video, and other media in any and all of its publications, including bulletin boards and website entries. I waive any right to royalties or other compensation arising or related to the use of the photographs or videos.

NO, please do not print or publish photos or videos of my child online or in churc-related publications

Parent/Guardian Signature Confirmation

Signature

Participant #1

Participant #2

Participant #3

Participant #4

Parent/Guardian Contact

Photo Release

Parent/Guardian Signature Confirmation

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