Youth Group Registration - Wye Bible Church

Child's Name*
First Last
*
Age*
Grade*
Birthday*
MM slash DD slash YYYY
Child's Name
First Last
Age
Grade
Birthday
MM slash DD slash YYYY
Child's Name
First Last
Age
Grade
Birthday
MM slash DD slash YYYY
Child's Name
First Last
Age
Grade
Birthday
MM slash DD slash YYYY
Parent's Name*
First Last
Contact Phone*
Email*
Parent's Name
First Last
Contact Phone
Email
Address*
Street Address City State ZIP Code
Home Phone (if applicable)
Emergency Contact*
First Last
Phone*
Emergency Contact
First Last
Phone
Allergies/Special Needs
Publication/Website Permission Form
I grant Wye Bible Church permission to record the image/voice of my child(ren) listed below and use the recording for non-commercial purposes. This recording may be in the form of a photograph, film audio or video tape, digital or other electronic format and may be used on the Wye Bible Church’s website or in publications. Published documents shall NOT include a child’s full name, home address, phone number or the full names of other family members. Photo captions shall not identify students by full name.
Select all that apply*
- Use of my child’s name in Wye Bible Church’s website and publication
- Use of my child’s picture in Wye Bible Church’s website and publications
- I do not give permission to use my child’s name or picture in Wye Bible Church’s website and publications
I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature.*
- By checking this box and typing my name below, I am electronically signing my application.
Signature of Parent or Legal Guardian*
First Middle Initial Last

Publication/Website Permission Form