In the Wild - VBS 2019
For 4 years old through completed- 6th grade
Sunday July 7th - Thursday July 11th (6:00 pm - 8:30 pm)
Thursday July 11th- Recognition Night & Family Ice Cream Social 6:00 p.m.
**PLEASE NOTE THAT A PARENT NEEDS TO ACCOMPANY CHILD INSIDE ON THE FIRST DAY TO COMPLETE & SIGN a MEDICAL RELEASE FORM (This form can be found on our website under forms and brought the first night of VBS)
Contact Information
Child's Name *
Your answer
Grade Completed *
Required
Parent/Guardian's Name *
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Phone Number *
Your answer
Emergency Contact #1 Name *
Your answer
Emergency Contact #1 Phone Number *
Your answer
Emergency Contact #2 Name *
Your answer
Emergency Contact #2 Phone Number *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Special Concerns: (allergies, medications, medical conditions) *
If none, please type NONE
Your answer
Person your child may leave with besides parent
Your answer
Phone number
Your answer
Do you attend church? *
If so, what church do you attend (optional)
Your answer
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