Deep Sea Mission VBS Registration 2017
Deep Sea Mission VBS will be hosted by Clarkston United Methodist Church from July 10th to 14th from 9 am to 12 pm. Pre-K through entering 6th grade are welcome. Participants must be potty-trained. Please complete registrations as soon as possible to secure your child's spot. Helpers are also welcome. Vacation Bible School is a ministry of Clarkston UMC, provided to the community free of charge. Please complete a registration form for each child. Please contact the church with any questions. (509) 758-7551, umc@clarkston.com, P.O. Box 183, 1242 Highland Avenue, Clarkston, WA 99403. More information about the church can be found at clarkstonumchurch.com.
Child's Name
Your answer
Age
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Birth Date
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DD
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YYYY
Grade (as of Fall 2017)
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Home Church (if appropriate)
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Address
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Parent or Guardian(s)
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Phone number(s) -Please note the best choice for reaching you during VBS
Your answer
Email (Optional)
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Emergency Contact Person
Name
Your answer
Relation to Child
Your answer
Phone Number(s)
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Pick-up information
For the safety of the children, all children will be signed in and out each day and will not be allowed to leave without an authorized adult, unless otherwise arranged with VBS staff. Who is authorized to pick your camper up?
Who is authorized to pick your camper up?
Your answer
Photo Permission
I give Clarkston United Methodist Church permission to use photos and videos of my child taken at VBS in future promotion of Clarkston United Methodist Church ministries.
Allergies
Please list all known allergies, including Medication, Food and Other. Please include reaction and how we should respond
Medication allergy
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Food allergy
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Other allergies
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Current medical conditions VBS staff should know about
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Doctor Information
Family Doctor
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Phone
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Address
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Restrictions to activities (what cannot be done or needs to be adapted)
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Additional information (Please provide information, such as behavioral, physical, emotional, or mental health needs, etc. so we may serve your child.)
Your answer
Parent or Guardian Authorization (This needs to be signed in person before child can participate. This can be signed during the event, or prior to the event at the church office)
-This health history is correct and complete to the best of my knowledge. I grant permission for
the child described to participate in VBS activities except as noted.
-I grant permission to the VBS staff to provide routine and emergency medical care as necessary.
I agree to release any records necessary for medical treatment, referral, billing or insurance purposes.
I give permission to the VBS staff to arrange necessary related transportation for the child.
-In the event that I cannot be reached, I give permission to the doctor listed above, or another available physician, to secure and administer treatment, including hospitalization, of the
child described.
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