Child’s full name

Preferred name/nickname

Date of birth / Age

Grade completed

Gender 

Parent/Guardian name(s)

Primary phone number

Secondary/emergency phone number

Email address

Home address

Name

Relationship to child

Phone number

Does your child have any allergies? (food, medication, environmental)

Does your child have any medical conditions we should be aware of?

What should we do in case of a medical emergency? 

Any food restrictions?

Is your child allowed to receive snacks provided by VBS?

Who is authorized to pick up your child? (list names)

Do you give permission for your child to be photographed/video recorded?

Can photos be used for church promotion (website, social media, etc.)?

Do you attend a church? If so, which one?

Has your child attended VBS before?

How did you hear about our VBS?

Signature

Date