Mahomet Christian Church
"Touching the world with God's Love...
                                      teaching them with His Word!"
Mahomet Christian Church
PO Box 679
908 N Lake of the Woods Rd
Mahomet, IL  61853
(217) 586-3095
2012
VBS ON-LINE
REGISTRATION
6:00-8:30 pm nightly
July 29 - August 2
4yo - 5th GRADE
Student's Name:
Parent/Guardian Name:
Address:
City, State, Zip:
E-Mail Address:
Phone Numbers:
Home                                                   Cell                                                        Work
Student's Grade:
Student's Age:
Home Church:
Emergency Contact Name:
Emergency Contact Number:
Emergency Contact Name:
Emergency Contact Number:
Who may pick up this child
at the end of each night:
PICTURE RELEASE:
We recognize that in a age of digital cameras, camera phones, video and DVD recordings and more,
your child's attendance and/or participation in this program may result in their picture being taken.  
Such pictures may be used in promotional materials, websites, newsletters and more.  In an ongoing
effort to protect all our children from danger and/or harm, we are endeavoring to obtain
parental/guardianship permission to use any minor child's picture in such manner.  Please indicate
below on behalf of the child registered above your desire in this matter.  Thank you for entrusting us
with your child for Vacation Bible School.
YES, I give my permission for MCC to use my child's picture.
NO, I do not wish my child's picture to be used.