Cave Adventure - VBS Registration Form
Cave Adventure VBS will be held from July 8 - 12, 9 AM to 11:30 AM for children age 4 years through entering grade 5. To register your child, please complete this registration form.
Child First Name *
Your answer
Child Last Name *
Your answer
Grade Entering, Fall 2019 *
Birthday *
MM
/
DD
/
YYYY
Parent Email Address *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Parent Home Phone
Your answer
Parent Cell Phone *
Your answer
Parent/Guardian First Name *
Your answer
Parent/Guardian Last Name *
Your answer
If your child is a guest of another VBS student, please list that child's name.
Your answer
What is your home church, if any?
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Relationship *
Your answer
Emergency Contact Phone Number *
Your answer
Medical Release - By typing my name below, I, the parent or guardian of the minor child named in this registration form, do hereby authorize adult VBS volunteers of Community Covenant Church, East Bridgewater, MA as agent(s), to consent to any medical care deemed advisable by any accredited physician or surgeon in an approved emergency clinic or hospital. *
Your answer
Please list any allergies (include medications, foods, insects, etc.). If none, please list NA. *
Your answer
Does your child have any medical, behavioral, or special needs, including medications currently being used? *
If yes, please explain
Your answer
Doctor's Name *
Your answer
Doctor's Phone Number *
Your answer
Please provide names of people with permission to pick up your child at the end of VBS. *
Your answer
Photo Release - By typing my name below, I give Community Covenant Church permission to use VBS photos of my child on the Church's website and/or in the church's newsletter, with the understanding that his/her name will not be published.
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service