UBC Vacation Bible School 2019
June 17-21, 2019 8:30-12:00!
* If you are registering multiple siblings, you only need to include address, emergency contacts, etc. once!
Child's Name
Your answer
Child's Age as of June 17, 2019
Your answer
Child's Date of Birth
MM
/
DD
/
YYYY
Last grade completed
Your answer
May we use photographs/videos of your child, without her/his name, on our church website and social media pages?
Name(s) of Parent(s)
Your answer
Parent e-mail address(es)
Your answer
Parent/Caregiver cell number(s)
Your answer
Home address
Your answer
Allergies/dietary restrictions?
Your answer
Mobility/accessibility/developmental needs?
Your answer
EMERGENCY CONTACT #1 (Name, relationship, phone number)
Your answer
EMERGENCY CONTACT #2 (Name, relationship, phone number)
Your answer
People (in addition to parents and emergency contact) who MAY pick up my child from VBS:
Your answer
People who may NOT pick up my child:
Your answer
Any of your child's friends who should (or should not) be in the same VBS group? (We will try to accommodate requests but cannot make any guarantees)
Your answer
Anything else you would like us to know?
Your answer
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