| WE CAN ONLY ACCEPT CHILDREN WHO COMPLETED KINDERGARTEN THRU 6TH GRADE. I give my permission for my child to take part in all VBS activities and absolve the church from liability to me or my child because of any injury at VBS during any activity. If you agree to the above, and give permission for your child to participate in VBS, please complete the following form. |
| *Participant's First Name: |
__________________________________ |
| *Participant's Last Name: |
__________________________________ |
| *Preferred Name for Name Tag: |
__________________________________ |
| *Parent/Guardian Name: |
__________________________________ |
| *Address: |
__________________________________ |
| *City: |
__________________________________ |
| *State: |
__________________________________ |
| *Zip: |
__________________________________ |
| *Primary Phone: |
(______)______-________ |
| *Cell Phone: |
(______)______-________ |
| *Email: |
__________________________________ |
| *Birthday: |
__________________________________ |
| *Last Grade Completed: |
__________________________________ |
| Allergies, Medical, & Special Needs: |
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| *Emergency Contact Name (1): |
__________________________________ |
| *Emergency Contact Phone (1): |
(______)______-________ |
| *Authorized Pickup #1: |
__________________________________ |
| Authorized Pickup #2: |
__________________________________ |
| Are you a member of this church?: |
Yes No (circle one) |
| Guest of: |
__________________________________ |
| Do you attend Church?: |
Yes No (circle one) |
| If so, where?: |
__________________________________ |
| May we have permission to photograph your child?: |
Yes No (circle one) |
| May we have permission to use your child's photograph in church publications?: |
Yes No (circle one) |
| Comments: |
|
| Gender: |
Male Female (circle one) |
