OVERCOMER-Overcomers Academy

Fill out the form below to register your CHILD! Thank you and God bless!

Vacation Bible School 2023

TODAY'S DATE*

Child's Information

Child's Name*

Gender*

Birthdate*

Grade Completed*

Address*

City*

State

Zip Code

PARENT/GUARDIAN INFORMATION

Parent/Guardian*

1st Number*( ) -

Parent /Guardian

2nd Number*( ) -

Guardian or Family member Number

Address*

EMERGENCY CONTACT INFORMATION

Name*

Relationship to Child*

Phone*( ) -

Who can pick up your child?*

Name of Home Church

Food Allergies

Yes

Child's Allergy Information

Medical Concerns

Yes

Medical Concern Information

PERMISSION TO USE IMAGES AND VIDEO

I hereby grant permission for Overcomers Academy Church to record sounds, images, or video of my child*

Child's Name

while attending this VBS program. I also give permission for Overcomers Academy Church at its sole discretion, to use these sounds, images, or videos in publications ( including print, websites, and social media platforms) owned by Overcomers Academy Chu*

PARENT/GUARDIAN NAME

Please leave this field blank.

VBS 2023

Fill out the form below to register your CHILD! Thank you and God bless!