Aulani VBS Registration
Event Timing: July 17-July 21; 6pm-8:30pm
Event Address: 961 Io Lane, 96817
Contact Mrs. Diandra at (808) 386-1255 or dee.ann.dra@gmail.com
Child Name[s] and Birthday[s]
Please list each child's first name, last name and birthday (ex: Hannah Banana 07/17/07)
Your answer
Parent's Name and Phone Number
Your answer
Secondary Emergency Name and Phone Number
Your answer
Address
Your answer
What days will you attend?
Required
Allergies
Your answer
I understand that I pick up is at 8:30pm
Required
I, the undersigned, hereby request and give permission for the above named child to participate in this activity, and, with this signed agreement, I release VIM Kids staff to the administration of first-aid and/or doctor’s care, or any other form of medical treatment necessitated by illness or injury that may require the same. In the event of the necessary of such care or treatment as hereto-fore described, the undersigned agrees to hold harmless and indemnify the directors, employees and agents from any wrongdoing, and/or failure to act on the part of those chosen to administer medical care on behalf of the participant. I (we) assume the responsibility of all medical bills, if any.
Digital Signature: Adult First & Last Name
Your answer
Questions/Comments/Concerns
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms