West River United Vacation Bible School Registration August 26th to 29th 2019
Child's name *
Your answer
Parent/Guardian's name *
Captionless Image
Your answer
Child's date of birth *
MM
/
DD
/
YYYY
Current age *
Your answer
Grade (going into) *
Your answer
Home Phone *
Your answer
Mobile Phone
Your answer
Home Address *
Your answer
Parent(s) E-mail *
Your answer
Allergies
(if applicable)
Your answer
Dietary Considerations
(if applicable)
Your answer
Other Health Concearns
(if applicable)
Your answer
Emergency Contact Information *
*Please list an individual other than above
Your answer
Emergency Contact Phone Number *
Your answer
Emergency Contact Relationship to youth or child *
Your answer
Other individual(s) allowed to pick up my child and their phone number *
Your answer
Other siblings attending Vacation Bible School
(if applicable)
Your answer
Church attended (if any)
(if applicable)
Your answer
Is there any other information we should know?
Your answer
Photo Release *
I understand that my child/ I may be photographed or recorded on video during the course of Sunday School/ Youth Group or general West River United Church activities. I provide consent for their/ my image to be used in print, electronic, or video form for display within the church, and/or the church's website and social media pages.
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