Emerald Crossing at Open Door Bible Church

Family Information

Address

Street

Street 2

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Postal Code

Parent/Guardian First Name

Parent/Guardian Last Name

Primary Phone

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Alternate Phone

Emergency Contact

Relationship to Student

Phone Number

Who can pick up the child? Please list anyone other than you who may pick up your child(ren).

Media Release Permission

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I do not accept the media permission

Media Permission: I hereby grant permission for Open Door Bible Church of Belton to record sounds, images, or videos of my child while attending this VBS program. I also permit Open Door Bible Church of Belton, at its sole discretion, to use these sounds, images, or videos in publications (including print, websites, and social media platforms) owned by Open Door Bible Church of Belton in relation to this VBS program.

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