Vacation Bible School : Stockton Fil-Am SDA Church Stockton CA

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Child 1

Birthdate

Age

Child 2

Birthdate

Age

Child 3 or more, please list down

Name(s)

Birthdates and Ages

Parents/Guardians

Phone Number

Address

Any other allergies, please fill up the form or See VBS Director, Fem Capoy

How did you hear about our VBS?

By clicking below, I hereby give permission for Stockton Fil-Am SDA Church to use my family's name and image and likeness and/or any interview statements from me or my children in its publications, advertising or other media activities (including the Internet) during this event. (a) Permission to interview, film, photograph, tape, or otherwise make a video reproduction of me and/or record my voice; (b) Permission to use my name; and (c) Permission to use quotes from the interview(s) (or excerpts of such quotes), the film, photograph(s), tape(s) or reproduction(s) of me, and/or recording of my voice, in part or in whole, in its publications, in newspapers, magazines and other print media, on television, radio and electronic media (including the Internet), in theatrical media and/or in mailings for educational and awareness. This consent is given in perpetuity, and does not require prior approval by me.

Yes/No

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