St. Aidan's Episcopal Church - VBS Registration
July 23-27, 2017. Dinner served at 5:30 pm, program 6 to 8 pm. For children preschool - 5th Grade.
Bible Lessons Based on Pets
Student's Name
Your answer
Student's Age
Your answer
Last grade completed
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Parent or Guardian Name
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Address
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City
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Zip Code
Your answer
Home Phone
Your answer
Work Phone
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Cell Phone
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Name of Emergency Contact in case parent cannot be reached
Your answer
Emergency Contact phone number
Your answer
Does this student have any allergies or medical concerns?
Your answer
Medical Insurance company name
Your answer
Medical Insurance policy number
Your answer
As the parent or legal guardian, do you hereby grant to the adult supervisors and leaders of St. Aidan’s Episcopal Church to make medical decisions with respect to said minor child in the event of an accident or injury when parental consent shall be unavailable or when circumstances shall require immediate medical decision, and to administer medication when required?
Required
I grant permission for my child to appear in photos or video recorded by St. Aidan's Episcopal Church during Vacation Bible School and for these photos to be used on their website and Facebook page.
Required
Enter your name here to sign this form (required)
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Today's Date
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YYYY
Please name all persons authorized to pick-up this student from VBS each evening (Student will not be allowed to leave with anyone not on this list.):
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