St. Timothy VBS 2022
If you or your child would like to participate in this event as a Participant, please complete the following form.

(If you are under 18, please have your parent or guardian complete the form.)
Personal Information
*Participant's First Name:
*Participant's Last Name:
*Preferred Name for Name Tag:
*Gender:
*Birthday:
(MM/DD/YYYY)
Is your child 4 years of age before July 1?
*T-Shirt Size:
*Grade in September:
*Last Grade Completed:
Buddy Request:
(Give name of buddy of the same age group)
If 7th-12th grader 1st choice volunteer position:
*Parent/Guardian Name:
Parent volunteering:
(Is Parent volunteering?)
*Address:
*City:
*State:
*Zip:
*Primary Phone:
(555-555-5555)
Work Phone:
(555-555-5555)
*Cell Phone:
(555-555-5555)
*Email:
Allergies, Medical, & Special Needs:
(Leave Blank if None)
Does your child have an EpiPen?:
*Emergency Contact Name (1):
*Emergency Contact Phone (1):
(555-555-5555)
Emergency Contact Name (2):
Emergency Contact Phone (2):
(555-555-5555)
*Authorized Pickup #1:
Authorized Pickup #2:
Authorized Pickup #3:
Authorized Pickup #4:
Are you a member of this church?
*What Parish do you attend?:
May we have permission to photograph your child?
May we have permission to use your child's photograph in church publications?
Comments:
2001-2024 Lifeway Christian Resources3.20.03
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