| VBS is for children completing Kindergarten – 5th grade. Children age 0-5 will not be able to participate unless their parent or caretaker is a registered VBS volunteer. |
| *Participant's First Name: |
__________________________________ |
| *Participant's Last Name: |
__________________________________ |
| *Parent/Guardian Name: |
__________________________________ |
| *Address: |
__________________________________ |
| *City: |
__________________________________ |
| *State: |
__________________________________ |
| *Zip: |
__________________________________ |
| *Primary Phone: |
(______)______-________ |
| *Cell Phone: |
(______)______-________ |
| *Email: |
__________________________________ |
| *Gender: |
Male Female (circle one) |
| *Birthday: |
__________________________________ |
| *Grade Completing Spring 2021: |
__________________________________ |
| Allergies, Medical, & Special Needs: |
|
| *Emergency Contact Name (1): |
__________________________________ |
| *Emergency Contact Phone (1): |
(______)______-________ |
| Emergency Contact Name (2): |
__________________________________ |
| Emergency Contact Phone (2): |
(______)______-________ |
| Parents: If you are picking up your child, please list yourself on the authorized pick up list. |
| *Authorized Pickup #1: |
__________________________________ |
| Authorized Pickup #2: |
__________________________________ |
| Authorized Pickup #3: |
__________________________________ |
| Authorized Pickup #4: |
__________________________________ |
| Do you attend Idlewild?: |
Yes No (circle one) |
| --OR-- |
| What church do you attend?: |
__________________________________ |
| Which of the following applies to your child?: |
Is a Christian
Wants to know more about becoming a Christian
Is not ready to accept Christ as Savior (circle one) |
| Does your child require a Spanish speaking class?: |
Yes No (circle one) |
| Would your child benefit by being in our self-contained Special Needs VBS group? |
| Special Needs: |
Yes No (circle one) |
