VBS 2017 Dates: July 31-Aug 3rd Time: 9am-NOON
VBS is for kids ages 4 years old to 8th grade.
If your child is in 7th or 8th grade, you must sign a release for your child to leave the building.
We hope that your child has a blast at VBS and that we see you and your family at our closing event.
Child's First Name: *
Your answer
Child's Last Name: *
Your answer
Street Address: *
Your answer
City: *
Your answer
State: *
Check all that apply.
Required
Zip Code: *
Your answer
Current age of child: *
Please us number only.
Your answer
Grade of child in the fall: (VBS ages are 4 years old through 8th Grade!) *
If your child is going into grade 7 or 8 you must sign an additional release form for your child to ride the bus to off premise activities.
Required
Birthday: *
Example: August 8, 2008
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Gender: *
Required
My child has the following allergy/sensitivities to: *
Check all that apply.
Required
My child has these limitations: *
Required
This is my electronic signature for my 7th or 8th grader to be transported on the church bus to off the premise activities: *
Please provide your full name for legal electronic signature.
Your answer
Parent's phone/Cell Number: *
Your answer
Parent's E-mail: *
If you do not have access to e-mail please enter "none".
Your answer
Parent or Guardian's Name: *
Your answer
Emergency Contact and phone number: *
Your answer
My child attends the following church: *
Check all that apply.
Required
Please provide insurance information, policy number and name of doctor: *
Your answer
I understand that, in the event, should medical treatment be required, every effort will be made to contact me. However, if I cannot be reached, I give permission to the adults in charge of Vacation Bible School 2017 to secure the services of a licensed physician to provide the care necessary, including anesthesia, for my child's well-being. I, the parent or legal guardian of the child listed above, also release Duluth Gospel Tabernacle and any adults in charge, from any and all claims resulting from injury or damage that may be sustained by my child while participating in Vacation Bible School during June 30-Aug3. *
Please provide your full name as legal electronic signature.
Your answer
The following person(s) are permitted to pick up my child: *
Remember to include yourself. Each day you will need to bring a child check-out card to pick up your child. This is for the safety of our children. Please remind your child to wait for you and to stay with you once they are picked up!
Your answer
The following person(s) are NOT permitted to pick up my child: *
Your answer
Thank you for registering your child for VBS. Please insert your name as an electronic signature allowing your child to attend VBS at Duluth Gospel Tabernacle. THANK YOU! *
Please provide full name as legal electronic signature.
Your answer
My child may be photographed: *
Required
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