REGISTRATION FORM FOR VACATION BIBLE SCHOOL

Child's Name*
Birthday M/D/YR*
Grade Completed*
Age*
Full Mailing Address *
Address Line 1
Address Line 2
City
State/Prov.
Postal Code
Gender*
Mother's/Guardian's Name & Phone Number during VBS time*
Father's/Guardian's Name & Phone Number during VBS time*
Home Phone
email address*
Home Church (if any)
Doctor's Name & Phone Number
Allergies/Medical issues/Special instructions
Person(s) authorized to pick up child:*
Emergency contact if parent/guardian can’t be reached (include name, number, & relationship to child):*
I give my permission to the staff to seek medical attention for my child if necessary while participating in the VBS program. I understand that all necessary precautions will be taken for my child’s safety. I will not hold the church, its staff, or those supervising liable.*
I give permission for my child to be photographed or videotaped for any lawful purpose associated with this VBS.*
Name of Parent or Guardian*
Date*