Vacation Bible School

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Parent Contact Details

Name of Guardian #1*

First Last

Phone*

Address*

Street Address Address Line 2 City State ZIP Code

Name of Guardian #2

First Last

Phone (Guardian #2)

Address (Guardian #2)

Street Address Address Line 2 City State ZIP Code

Child #1

Name*

First Last

Child #1

Nickname

Child #1

Gender*

Child #1

Age*

Child #1

Date of Birth*

MM slash DD slash YYYY

Child #1

Grade*

Child #1

Allergies or other medical conditions 1*

Yes

Child #1

Please describe allergies and reactions 1*

Child #1

Any special circumstances? 1*

Yes

Child #1

Please special circumstances and any specific things we can do to help and make sure your child has the best time possible 1*

Child #1

Child #2

Name

First Last

Child #2

Nickname

Child #2

Gender

Child #2

Age

Child #2

Date of Birth

MM slash DD slash YYYY

Child #2

Grade

Child #2

Allergies or other medical conditions 2

Yes

Child #2

Please describe allergies and reactions 2

Child #2

Any special circumstances? 2

Yes

Child #2

Please special circumstances and any specific things we can do to help and make sure your child has the best time possible 2

Child #2

Child #3

Name

First Last

Child #3

Nickname

Child #3

Gender

Child #3

Age

Child #3

Date of Birth

MM slash DD slash YYYY

Child #3

Grade

Child #3

Allergies or other medical conditions 3

Yes

Child #3

Please describe allergies and reactions 3

Child #3

Any special circumstances? 3

Yes

Child #3

Please special circumstances and any specific things we can do to help and make sure your child has the best time possible 3

Child #3

Child #4

Name

First Last

Child #4

Nickname

Child #4

Gender

Age

Date of Birth

MM slash DD slash YYYY

Grade

Allergies or other medical conditions 4

Yes

Please describe allergies and reactions 4

Any special circumstances? 4

Yes

Please special circumstances and any specific things we can do to help and make sure your child has the best time possible 4

Emergency Information

Name*

First Last

Relationship to Child*

Phone*

Do we have permission to call 9-11 if there were an emergency specifically involving your child?*

Yes

Who will be picking up child(ren) at the end of each day?*

Guardian #1

Guardian #2

Someone Else

Please specify who will be picking up your child(ren)*

Photography Agreement

Do we have permission to take photos of your child?*

Yes

If yes, please choose where you would allow the photos to be displayed

Photo placement preference*

Photos displayed during a church service

Church Website

Instagram

Facebook

Vacation Bible School

Matthew 19:14

Jesus said, “Let the little children come to me, and do not hinder them, for the kingdom of heaven belongs to such as these.”

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