ROAR! VBS Registration Form
Use this form to register your child for ROAR! Vacation Bible School at Richland Center Free Methodist Church. Thank you!
Email address *
Child's Name *
Your answer
Child's Birthdate *
MM
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DD
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YYYY
Child's Age *
Your answer
What grade was the child in last school year? *
Parent/Guardian Name (first and last please) *
Your answer
Parent/Guardian Full Address *
Your answer
Parent/Guardian Cell Phone Number *
Your answer
Parent/Guardian Email Address
Your answer
Does your child have any allergies? *
If yes, please list all allergies.
Your answer
Please list any other medical or behavioral needs/conditions the child has that may impact their participation in Roar.
Your answer
Photo/Video Release: My child may be photographed and/or videoed while participating in Roar! VBS activities. I understand such media will only be used by RCFM for promotional purposes, and that my child will never be referenced by name or other specific information in any electronic or printed materials. *
Medical Release: By submitting this form, I confirm that I understand all reasonable safety precautions will be taken at all times during the VBS event to protect my child from injury. I understand the possibility of unforeseen hazards and injury. I further understand that in the event medical intervention is needed for my child, an attempt will be made to immediately contact the persons listed as Emergency Contacts on this form. In the unlikely event that no one can be reached in an emergency, I give my permission for Richland Center Free Methodist Church staff to call 911 and request emergency services and/or to render any such aid as is necessary for the health, well-being, and safety of my child. *
Required
Please list below at least two (2) Emergency Contacts. List name, relationship to child, and valid phone number (including area code). *
Your answer
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