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ACC Vacation Bible School 2018
July 9th - 13th, 6-8 PM (Community Dinner at 5:15 PM each night!)
Join us as we adventure to
Child's Name *
Your answer
Child 2 *
Your answer
Parent/Guardian's Name *
Your answer
Address *
Your answer
Home Phone *
Your answer
Cell Phone
Your answer
Parent's Email
Your answer
Child's Birth Date *
Your answer
Child 2 Birth Date *
Your answer
Last Grade Completed in School *
Your answer
Child 2 Last Grade Completed in School *
Your answer
Medical or other information we need to know (for all children)
Please include any food allergies.
Your answer
Emergency Contact #1 *
Name AND Phone Number
Your answer
Emergency Contact #2 *
Name AND Phone Number
Your answer
Dismissal Information *
Who may pick up your child/children after VBS each day? List all possible names.
Your answer
Other Information *
Do you attend a local church? Which one?
Your answer
Visitor Info
How did you hear about VBS at ACC?
Your answer
Photo Permission *
May we have permission to photograph your children?
Photo Permission *
May we have permission to use your child’s photograph to sharing ACC's programs with the media?
First Aid/Emergency Medical Permission *
May we have permission to administer first aid to your children and/or authorize emergency medical treatment for your children should the need arise during VBS related activities? (Should any injury occur you will be notified at pickup or asap if more than an ice pack or bandaid is necessary.) Director is First Aid and CPR certified.
Parent/Guardian Signature *
(type full name)
Your answer
Date *
Your answer
Would you like to volunteer during VBS? *
If YES, which area would you like to be involved in?
Community Dinner during VBS *
This year we invite you to join us for dinner at 5:15 PM each evening!
IF YES...How many people will be joining us for dinner?
Your answer
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