Faith Mennonite VBS Registration 2017
Please complete a separate copy of this form for each child you are registering
Birthdate of Child *
MM
/
DD
/
YYYY
Name of Child? *
Your answer
Names and Address of Parents (full address including city and postal) *
Your answer
Allergies or Medical Concerns? *
Your answer
Last School Grade *
Your answer
Health Card Number *
Your answer
Home Phone Number? *
Your answer
Cell/Emergency Number *
Your answer
Other Caregiver (alternate Contact- Name and Phone Number_ *
Your answer
Waiver of Responsibility *
I give the above registered child permission to participate in this Vacation Bible School Program. Faith Mennonite VBS and Church will be indemnified and held harmless in the event of injury or accident. My completion of this form indicates my acceptance of this waiver. In signing this waiver, I also grant permission to Faith Vacation Bible School to use photos and video of my child(ren) for in house programming only, (not to be used online or in promotional material.)
Name of Person Completing Registration and Accepting Waiver
Your answer
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