VBS Registration Form - 2021
Please fill out one form per child.
General Information
Child's Name: *
Grade just completed (in June 2021): *
Address: *
Main Contact Phone Number: *
Emergency Contacts
Please provide the name, phone number, and relationship status of two emergency contacts. In case we are unable to reach you, we will contact these names in descending order.
Emergency Contact #1: *
Emergency Contact #2: *
Allergy & Medical Information
Does you child have any food allergies? *
If yes, please list:
Does you child have any other medical issues that we should be aware of? If yes, please list: *
Permission to Photograph
Please provide a signature for the following photo permission statement. If you decline permission, please write N.A. in the box instead.
I hereby give permission for my child to appear in photographs taken in connection with activities of the VBS at Third Reformed Presbyterian Church. *
Pickup Procedure
Please check one of the boxes below. *
If your child is being picked up, provide the name and relationship status of the person designated to do so.
If there is someone who should NOT pick up your child, provide their name and relationship status below.
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