Child's Name *
Child's Name
Address *
Parent/Guardian Name *
Parent/Guardian Name
Emergency Phone *
Emergency Phone
Alternate Phone
Alternate Phone
T-Shirt Size *

*By registering my child for the Galena Park Church of God 7th Day VBS, I am authorizing it and/or parties designated to photograph my child and use photographs in all forms of media, for purposes of publicity, display and audiovisual use.  I understand that the term photograph, as used herein, encompasses both still photographs, audio recording and motion picture footage.  I hereby release Galena Park Church of God Seventh Day and any of its associates from any claims associated with COPPA.