Sign in to Google to save your progress. Learn more
Email *
Child’s Name (First & Last) *
Grade Level (2022-2023 School Year) *
Child's Birthday *
Parent/Guardian Name(s) *
Parent/Guardian Phone Number *
Parent/Guardian Email *
Emergency Contact (Name & Phone Number) *
Does your child have any food allergies or medical conditions? *
Anything else we should know about your child?
I give my child permission to attend Vacation Bible School at South Jefferson Christian Church and I understand that I will have to pick up my child promptly at 3 PM.  *
Please type Parent/Guardian Name below to consent to SJCC Video/Photo Release *
Captionless Image
A copy of your responses will be emailed to the address you provided.
Clear form
Never submit passwords through Google Forms.
This form was created inside of South Jefferson Christian Church. Report Abuse